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University at Buffalo School of Dental Medicine fax number

(716) 829-2242

Patient Records / Medical Records

Used for: Medical records requests / records release communications

Fax destination details

Department
Patient Records / Medical Records
Purpose
Medical records requests / records release communications
Form
Records Request Form — Authorization for Release of Health Information Pursuant to NYS Law
Address
102 Squire Hall, Buffalo, NY 14214-8006
Voice phone
716-829-2824

Before you send

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  • 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.

Submit this form via one of three options: (a) scan and upload the completed form to the patient portal, (b) fax to 716-829-2242, or (c) mail to Attn: Medical Records, University at Buffalo School of Dental Medicine, 102 Squire Hall, Buffalo, NY 14214-8006.

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

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