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Westside Pediatric Group, LLP fax number
(585) 319-4124
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Medical Records / PHI Release
Used for: Receiving and processing medical records requests and PHI (Protected Health Information) release forms.
Fax destination details
- Department
- Medical Records / PHI Release
- Purpose
- Receiving and processing medical records requests and PHI (Protected Health Information) release forms.
- Form
- Release of PHI Authorization — Release of Protected Health Information (PHI) Authorization
- Address
- 497 Beahan Rd, Rochester, NY 14624-3403
- Voice phone
- 585-247-5400
- 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.
The form explains that authorization is voluntary, may be revoked in writing, that disclosures may be redisclosed if the recipient is not a covered entity, and that charges may apply for records requests.
Official form instructions are published as a downloadable file on the organization's website.
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