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Retina Institute of Virginia, PLLC fax number
(804) 644-8224
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Medical Records
Used for: Medical records release requests (Authorization to Release Healthcare Information)
Fax destination details
- Department
- Medical Records
- Purpose
- Medical records release requests (Authorization to Release Healthcare Information)
- Form
- Authorization to Release Healthcare Information
- Address
- 8720 Stony Point Pkwy, Suite 105, Richmond, VA 23235
- Voice phone
- 804-644-7478
- 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.
Fill patient name and date of birth, physician/practice, recipient details, and the specific records to release; sign and date; the form expires one year from the signature date.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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