Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with UCHealth Memorial Administrative Center before sending sensitive documents. FaxFlow is not affiliated with this organization.
UCHealth Memorial Administrative Center fax number
(719) 365-6974
Medical Records / Release of Information (ROI)
Used for: Release of medical records and HIPAA-authorized disclosures; requests for patient information.
Fax destination details
- Department
- Medical Records / Release of Information (ROI)
- Purpose
- Release of medical records and HIPAA-authorized disclosures; requests for patient information.
- Form
- Authorization to Disclose PHI (Health Information) - HIPAA — Authorization to Disclose PHI
- Address
- Memorial Administrative Center, 2420 E. Pikes Peak Avenue, Colorado Springs, CO 80909
- Voice phone
- 719-365-5000
- 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 in patient name, date of birth, and current address; specify the purpose of disclosure; indicate the recipient/organization; provide date range or service dates; sign and date; attach a copy of a valid ID if required; fees may apply for paper copies.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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