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WellOne Primary Medical and Dental Care – North Kingstown (Northwest Community Health Care) fax number
(401) 295-0920
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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
- 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 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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