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SSM Health St. Anthony Hospital - Shawnee fax number

(405) 878-8162

Medical Records (Health Information Management)

Used for: Medical records request / release of information via fax

Fax destination details

Department
Medical Records (Health Information Management)
Purpose
Medical records request / release of information via fax
Form
Authorization for Use and Disclosure of Protected Health Information — Authorization for Use and Disclosure of Protected Health Information
Address
1102 W. MacArthur St., Shawnee, OK 74804
Voice phone
405-878-8160

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  • 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 form with patient name, birth date, information to be released, and recipient details; specify the purpose of disclosure and sign/date. The form is used to request access to or disclosure of protected health information.

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

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