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SimonMed Imaging fax number

(602) 302-5958

Medical Records

Used for: Medical records requests / Authorization to Release Protected Health Information

Fax destination details

Department
Medical Records
Purpose
Medical records requests / Authorization to Release Protected Health Information
Form
Authorization to Release Protected Health Information — Authorization to Release Protected Health Information
Address
2620 N 3rd Street, Ste. #100, Phoenix, AZ 85004
Voice phone
602-682-5014

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 out the Authorization to Release Protected Health Information and fax to 602-302-5958 or email to MedRecReq@SimonMed.com to obtain your records.

Official form instructions are published as a downloadable file on the organization's website.

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