Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Waukesha Memorial Hospital (ProHealth Care) before sending sensitive documents. FaxFlow is not affiliated with this organization.
Waukesha Memorial Hospital (ProHealth Care) fax number
(262) 544-9489
Health Information Management / Medical Records
Used for: Submitting MyChart Inactivation Form to deactivate proxy access and manage patient data releases (MyChart inactivation).
Fax destination details
- Department
- Health Information Management / Medical Records
- Purpose
- Submitting MyChart Inactivation Form to deactivate proxy access and manage patient data releases (MyChart inactivation).
- Form
- AD-40 — MyChart Inactivation Form
- Address
- 725 American Ave, Waukesha, WI 53188
- Voice phone
- 262-928-1000
- 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.
Fill out the Inactivation Form as shown in the document and submit by fax to 262-544-9489 or mail to Health Information Management, ProHealth Care, Inc., N17 W24100 Riverwood Drive, Waukesha, WI 53188.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
FaxFlow records the public sources found during directory research. A source link is useful evidence, but it is not a guarantee that a number still reaches the same team.
No public source link was saved with this record. Confirm the number directly with the organization before using it.