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Shirley Ryan AbilityLab fax number
(312) 238-2900
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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.
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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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