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UC Health — West Chester Hospital fax number

(513) 298-7765

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Medical Records Department

Used for: Authorization for Release of Patient Protected Health Information (PHI); medical records release

Fax destination details

Department
Medical Records Department
Purpose
Authorization for Release of Patient Protected Health Information (PHI); medical records release
Form
Authorization for Release of Information (ROI) — Authorization for Release of Patient Protected Health Information
Address
West Chester Hospital, 7777 University Drive, Suite A, West Chester, OH 45069
Voice phone
513-298-7750

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 out the ROI form with patient name, date of birth, and recipient; specify records to release; sign and date; fax to 513-298-7765.

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

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