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 It may be out of date, incomplete, incorrect, or in rare cases wrong entirely, and it is not confirmed by UT Southwestern Medical Center (UTSW). Before sending anything sensitive, confirm the number and receiving department directly with UT Southwestern Medical Center (UTSW), 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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UT Southwestern Medical Center (UTSW) fax number
(214) 645-9141
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Health Information Management – Release of Information
Used for: Authorization to Disclose Protected Health Information (PHI) and release of medical records
Fax destination details
- Department
- Health Information Management – Release of Information
- Purpose
- Authorization to Disclose Protected Health Information (PHI) and release of medical records
- Form
- PHI Authorization Form — Authorization to Disclose Protected Health Information (PHI)
- Address
- 5323 Harry Hines Boulevard, Dallas, TX 75390-8525
- Voice phone
- 214-645-3030
- 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.
Instructions for completing the PHI authorization: fill in patient name, DOB, contact info; specify what records to disclose; select delivery method (fax, email, mail, or MyChart); hand-sign; electronic signatures are not accepted; return to Health Information Management; fees may apply as per Texas state guidelines.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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