Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Shirley Ryan AbilityLab before sending sensitive documents. FaxFlow is not affiliated with this organization.
Shirley Ryan AbilityLab fax number
(312) 238-2900
Medical Records Department
Used for: Medical records request / Release of Protected Health Information
Fax destination details
- Department
- Medical Records Department
- Purpose
- Medical records request / Release of Protected Health Information
- Form
- Authorization to Release Protected Health Information (HIPAA Release Form) — Authorization to Release Protected Health Information
- Address
- 355 East Erie Street, Chicago, IL 60611
- Voice phone
- 312-238-6185
- 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.
Complete patient information, specify the information to be released, delivery method, and dates; sign and date; the form remains valid for one year unless revoked; fax to 312-238-2900 or mail to Shirley Ryan AbilityLab Medical Records Department, 355 East Erie Street, Chicago, IL 60611.
Official form instructions are published as a downloadable file on the organization's website.
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