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 It may be out of date, incomplete, incorrect, or in rare cases wrong entirely, and it is not confirmed by Univera Healthcare. Before sending anything sensitive, confirm the number and receiving department directly with Univera Healthcare, 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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Univera Healthcare fax number
(315) 671-7079
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Privacy/PHI (PHI authorization)
Used for: Submitting and processing authorization to disclose protected health information (PHI); often used to authorize release of medical records or HIV-related information.
Fax destination details
- Department
- Privacy/PHI (PHI authorization)
- Purpose
- Submitting and processing authorization to disclose protected health information (PHI); often used to authorize release of medical records or HIV-related information.
- Form
- Authorization Release Form (PHI) — Authorization to Disclose Protected Health Information (PHI)
- Address
- P.O. Box 211256, Eagan, MN 55121
- Voice phone
- 1-800-499-1275
- 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 Parts A–E on the form (member data, recipient, information to disclose, and signatures); return to Univera Healthcare by mail or fax. For NY HIV-related releases, a separate NY form is required as indicated on the form.
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