Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Venice Family Clinic before sending sensitive documents. FaxFlow is not affiliated with this organization.

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Venice Family Clinic fax number

(310) 943-3521

Medical Records

Used for: Medical records release / authorization for release of health information

Fax destination details

Department
Medical Records
Purpose
Medical records release / authorization for release of health information
Form
Medical Records Release Authorization — Authorization for Release of Health Information
Address
604 Rose Avenue, Venice, CA 90291
Voice phone
(310) 392-8636

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.

Fill out patient information (name, DOB, MR#), indicate recipient, select type of records to release, state the purpose and duration, and sign/date. Return to Venice Family Clinic Medical Records. If needed, provide witness or case manager details.

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

Sources and verification

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