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 It may be out of date, incomplete, incorrect, or in rare cases wrong entirely, and it is not confirmed by Providence Little Company of Mary - San Pedro Medical Center. Before sending anything sensitive, confirm the number and receiving department directly with Providence Little Company of Mary - San Pedro Medical Center, 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 Little Company of Mary - San Pedro Medical Center fax number
(310) 514-5404
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Release of Information
Used for: Fax-based release of medical records / ROI requests (Release of Information) for patient records.
Fax destination details
- Department
- Release of Information
- Purpose
- Fax-based release of medical records / ROI requests (Release of Information) for patient records.
- Form
- Patient Request to Access/Disclose a Designated Record Set; Authorization for Disclosure form — Patient Request to Access/Disclose a Designated Record Set; Authorization for Disclosure (English); Autorización para usar, divulgar y liberar información de salud protegida (Spanish)
- Address
- 1300 W. 7th St., San Pedro, CA 90732
- Voice phone
- +1-310-514-5260
- Website
- Visit organization website
Before you send
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Submit forms by fax to ROI; include patient name, date of birth, recipient, records to disclose, delivery method, signature and date; specify facility and dates of treatment as needed; expiration if applicable.
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