The Women's Center fax number

Fax destination details

Department

OB/GYN

Purpose

Medical records release requests (Authorization for Release and Use of Protected Health Information under HIPAA).

Form

Authorization for Release and Use of Protected Health Information — Authorization for Release and Use of Protected Health Information

Address

Multiple Central Florida locations (Winter Park: 147 Moray Lane, Winter Park, FL 32792; St. Cloud: 2916 17th St, St. Cloud, FL 34769; Orlando / Hunter's Creek: 3000 Hunter's Creek Blvd, Orlando, FL 32837; other locations include Downtown Orlando, Oviedo, Ocoee, Altamonte Springs, Celebration, Lake Nona).

Voice phone

407-857-2502

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, SSN, date of birth; specify records to release and recipient; indicate the purpose (e.g., further medical care, insurance); sign and date; the authorization may be revoked; fee is $1.00 per page up to 25 pages; processing time up to 72 hours; authorization expires after 90 days.

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