Requests for PHI

Requests for PHI by healthcare providers must be submitted via fax and include the following:

• Patient Name and Date of Birth (Social Security Number if available)
• The date(s) of service being requested
• The fax number to which the records will be faxed
• Contact information of the requestor including name and telephone number

Send requests to fax number:  (740) 779-7059

Questions/Concerns, call:  (740) 779-7640