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The Women's Center fax number

(407) 857-1855

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OB/GYN

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

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

Before you send

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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 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.

Sources and verification

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