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Healthcarehigh confidence

The University of Kansas Health System fax number

(913) 588-2495

Health Information Management (HIM) / Release of Confidential Information (ROI)

Used for: Request medical records / Release of confidential health information

Fax destination details

Department
Health Information Management (HIM) / Release of Confidential Information (ROI)
Purpose
Request medical records / Release of confidential health information
Form
MRD-1076 — Authorization for the Release of Confidential Information
Address
4000 Cambridge St, MS 9345, Kansas City, KS 66160
Voice phone
913-588-2454

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.

Complete the authorization form with patient details, specify the recipient of the records, dates of service, and the PHI to be released; sign and date; submit via mail, email, or fax to Health Information Management. Be aware there may be copying fees. Return to ROI@kumc.edu or fax 913-588-2495.

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