Directory information — verify before you send. This fax number was compiled by automated research from public sources. It may be out of date, incomplete, incorrect, or in rare cases wrong entirely, and it is not confirmed by Southwest Urologic Specialists, P.C.. Before sending anything sensitive, confirm the number and receiving department directly with Southwest Urologic Specialists, P.C., and consider sending a test cover page first. FaxFlow is an independent directory, is not affiliated with, endorsed by, or sponsored by this organization, and accepts no liability for reliance on this listing.
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Southwest Urologic Specialists, P.C. fax number
(480) 892-3035
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Medical Records
Used for: Authorization for Disclosure of Patient Health Care Information; record release
Fax destination details
- Department
- Medical Records
- Purpose
- Authorization for Disclosure of Patient Health Care Information; record release
- Form
- Authorization for Disclosure of Patient Health Care Information — Authorization for Disclosure of Patient Health Care Information
- Address
- 6007 E Baseline Rd, Suite 105, Mesa, AZ 85206
- Voice phone
- (480) 897-2727
- 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; provide address; indicate which records to release (complete records, lab reports, X-rays/imaging, office notes, pathology); designate recipient; sign and date; if someone else signs, specify the relationship; form expires after one year unless otherwise stated; for HIV/AIDS, sexually transmitted disease, psychiatric/mental health, or drug treatment information, additional consent may be required.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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