Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Tift Regional Medical Center before sending sensitive documents. FaxFlow is not affiliated with this organization.
Tift Regional Medical Center fax number
(229) 353-7779
Medical Records / Health Information Management
Used for: Medical records release / PHI release requests
Fax destination details
- Department
- Medical Records / Health Information Management
- Purpose
- Medical records release / PHI release requests
- Form
- PHI Release Authorization (HIPAA) — Authorization to Release / Obtain Protected Health Information
- Address
- 901 E 18th St E, Tifton, GA 31794-3648
- Voice phone
- 229-382-7120
- 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, medical record number, date of birth, and last 4 digits of SSN if required; select TRHS facility(ies); specify the health information to be disclosed; indicate purpose; sign and date. This Authorization may be revoked in writing to the Health Information Management Department. The form expires on a specified date or event (default is 90 days from signing).
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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