Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Providence Little Company of Mary - San Pedro Medical Center before sending sensitive documents. FaxFlow is not affiliated with this organization.
Providence Little Company of Mary - San Pedro Medical Center fax number
(310) 514-5404
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
- Confirm that this exact department handles your document or request.
- 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.
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.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
FaxFlow records the public sources found during directory research. A source link is useful evidence, but it is not a guarantee that a number still reaches the same team.
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