Directory information — verify before you send. This fax number was compiled by automated research from public sources. It may be out of date, incomplete, incorrect, or in rare cases wrong entirely, and it is not confirmed by UCHealth Memorial Administrative Center. Before sending anything sensitive, confirm the number and receiving department directly with UCHealth Memorial Administrative Center, and consider sending a test cover page first. FaxFlow is an independent directory, is not affiliated with, endorsed by, or sponsored by this organization, and accepts no liability for reliance on this listing.
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UCHealth Memorial Administrative Center fax number
(719) 365-6974
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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.
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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.
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