WebSelf-Service, Authorization Forms & Drop Box *Effective December 2024 University of Miami Hospital & Clinics (UMHC/SCCC) 1475 N.W. 12th Avenue, Room C003 Miami, Florida 33136 Phone: 305-243-5272 Fax: 305-243-5274 Bascom Palmer Eye Institute (BPEI) 900 N.W. 17th Street Miami, Florida 33136 Phone: 305-326-6333 Fax: 305-547-3709 What … WebAuthorization for Release of Health Information VD001 (9/28/21) Page 2 of 3 4. Verbal _____ PLEASE INITIAL HERE to authorize the person or a representative from the entity …

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WebFax Fax your completed Authorization Form to: 919-966-6295 Mail Please send your completed Authorization Form to: UNC MEDICAL INFORMATION MANAGEMENT … WebMedical Records. To access your records or request additional records, you may do so through Mass General Brigham Patient Gateway . You may also fax an authorization form to the Release of Information team at 617-726-3661 or mail that completed form to 121 Innerbelt Road, Somerville, MA 02143-4453. If you have questions regarding a specific ... cole haan howland penny driver

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WebUNC REX Healthcare Raleigh, NC WebIf you have any questions about your health, contact your physician or healthcare provider directly. If you do not have a physician, call SolutionHealth Provider Match at 833-920-7473. Mailing Address: Southern New Hampshire Health. 8 Prospect Street, PO Box 2014. Nashua, NH 03061. (603) 577-2000. Directions >. Helpful Telephone Numbers. WebThere are three ways to submit requests: MyUofMHealth Patient Portal Medical Record Request form. Mail to: Revenue Cycle Mid Service (HIM), Release of Information (ROI) Unit, 3621 S. Street 700 KMS Place, Ann Arbor MI 48108-1633. Fax: 734-936-8571. cole haan houston tx