Directory information — verify before you send. This fax number was compiled by automated research from public sources. It may be out of date, incomplete, incorrect, or in rare cases wrong entirely, and it is not confirmed by Providence Health & Services (Oregon Region). Before sending anything sensitive, confirm the number and receiving department directly with Providence Health & Services (Oregon Region), and consider sending a test cover page first. FaxFlow is an independent directory, is not affiliated with, endorsed by, or sponsored by this organization, and accepts no liability for reliance on this listing.

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Providence Health & Services (Oregon Region) fax number

(503) 215-0405

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Release of Information (ROI) Central Reception / Health Information Management

Used for: Medical records release / PHI disclosure requests

Fax destination details

Department
Release of Information (ROI) Central Reception / Health Information Management
Purpose
Medical records release / PHI disclosure requests
Form
Authorization to Use, Disclose & Release Protected Health Information — AUTHORIZATION TO USE, DISCLOSE & RELEASE PROTECTED HEALTH INFORMATION
Address
P.O. Box 4950, Portland, OR 97208
Voice phone
503-215-7425

Before you send

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  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
  • Keep the delivery confirmation with your submission records.

Form explains authorization to disclose health information, what records may be released, purpose, any limitations, optional directions (fax, email, etc.), and expiration (typically 180 days). Signature required. Certain information may be restricted by state/federal law.

Official form instructions are published as a downloadable file on the organization's website.

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