Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with UCLA Health before sending sensitive documents. FaxFlow is not affiliated with this organization.
UCLA Health fax number
(310) 825-3205
Health Information Management Services (Release of Information)
Used for: Medical records release / authorization for health information
Fax destination details
- Department
- Health Information Management Services (Release of Information)
- Purpose
- Medical records release / authorization for health information
- Form
- UCLA Form #30910 (Authorization for Release of Health Information) — Authorization for Release of Health Information
- Address
- UCLA Health, Health Information Management Services, 10833 Le Conte Ave, CHS BH-902, Los Angeles, CA 90095-1776
- Voice phone
- (310) 825-6021
- 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.
Complete all required fields on the authorization form, specify which records to release, designate the recipient and destination, indicate purpose and expiration, and sign/date. If releasing sensitive information (e.g., mental health), follow any additional checkboxes. Submit via the methods listed on the form (fax or mail) to UCLA Health ROI.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
FaxFlow records the public sources found during directory research. A source link is useful evidence, but it is not a guarantee that a number still reaches the same team.
No public source link was saved with this record. Confirm the number directly with the organization before using it.