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Southern Maryland Orthopaedic & Sports Medicine Center (a location of The Centers for Advanced Orthopaedics) fax number

(301) 475-5914

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Orthopedics

Used for: Medical records requests / release of medical information

Fax destination details

Department
Orthopedics
Purpose
Medical records requests / release of medical information
Form
Medical Records Release Authorization — Authorization to Release Medical Record Information
Address
23000 Moakley Street, Suite 102, Leonardtown, MD 20650
Voice phone
301-475-5555

Before you send

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Complete patient details (name, DOB, SSN, address), specify the treatment dates, and check which records to release (entire record, diagnostic studies, operative reports, etc.). Include recipient information and sign/date. HIPAA permissions apply; per the form, records may be released via various methods (including fax) to the authorized recipient.

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