Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with WellOne Primary Medical and Dental Care – North Kingstown (Northwest Community Health Care) before sending sensitive documents. FaxFlow is not affiliated with this organization.

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WellOne Primary Medical and Dental Care – North Kingstown (Northwest Community Health Care) fax number

(401) 295-0920

North Kingstown Office

Used for: Medical records release / authorization for Release of Protected Health Information (ROI) requests

Fax destination details

Department
North Kingstown Office
Purpose
Medical records release / authorization for Release of Protected Health Information (ROI) requests
Form
Authorization for Release of Protected Health Care Information (HIPAA ROI) — Authorization for Release of Protected Health Care Information
Address
308 Callahan Rd, North Kingstown, RI 02852
Voice phone
401-295-9706

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 patient name, date of birth, and address; specify recipient and fax/address for records; choose release scope (entire health record or limited data); sign and date; submit via fax or mail as instructed.

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

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