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Via Christi Health (Ascension Via Christi) fax number
(316) 274-5371
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Health Information Management (HIM) Department
Used for: Medical records requests and other protected health information disclosures
Fax destination details
- Department
- Health Information Management (HIM) Department
- Purpose
- Medical records requests and other protected health information disclosures
- Form
- VAADMIN020 — Authorization for Use or Disclosure of Protected Health Information (PHI)
- Address
- 1947 Founders Circle, Wichita, KS 67206
- Voice phone
- 316-274-4995
- 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 sections of the PHI authorization form (VAADMIN020 Rev. 03/2022). Indicate the PHI requested, dates of treatment, purpose, and expiration (default to 1 year). Sign and date; submit to HIM Department at 1947 Founders Circle, Wichita, KS 67206 or fax to 316-274-5371 or 316-274-5372. For radiology images, use Fax 316-274-8785. Processing may take up to 12 business days; for status, contact HealthPort at 1-800-367-1500.
Official form instructions are published as a downloadable file on the organization's website.
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