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Click ‘Get Form’ to open the release of information document in the editor.
Begin by entering your full name and date of birth in the designated fields at the top of the form. Ensure accuracy for proper identification.
Provide your Social Security Number (SS#) in the specified field, as this may be required for verification purposes.
In the section labeled 'I AUTHORIZE CITRUS ORTHOPAEDIC & JOINT INSTITUTE TO RELEASE INFORMATION TO', fill in the name and address of the individual or organization receiving your medical information.
Complete the phone number and fax number fields to ensure that communication can occur smoothly.
Specify the reason for disclosure in the provided space, detailing why you are requesting this information to be shared.
Review and understand the authorization statement regarding your medical information, then sign and date where indicated. If applicable, include your relationship to the patient if you are a legal representative.
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What is the fax number for eviCore medical records?
Fax an eviCore healthcare request form (available online) to 800-540-2406; for sleep study requests fax to 888-693-3210.
What is the fax number for change healthcare medical records?
How do I submit medical records that been requested? For fastest processing, the records may be emailed to our secure email address medicalrecords@changehealthcare.com or faxed to our secure fax at 949-234-7603.
How do I fax my medical records?
Using Traditional Fax Machines to Fax Medical Records Create a confidential fax cover letter and print it out. Print the medical records. Enter the receiving fax phone number into your fax machine. Feed the fax documents into the machine, starting with the cover sheet. Send the fax.
What is the fax number for citrus orthopedic and joint institute medical records?
Once Forms are complete, please send to forms@citrusortho.net or send via a portal message or fax to 352-746-6907 for expedited service or bring to appt.
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Corporate Integrity Agreements List | Healthcare Compliance
Agreements with multiple parties are generally listed alphabetically by the first named party. Please use the filter tool below to search agreements by party
and Shoji, H.: Secondarily Infected Total Joints by Hematogenous Spread. Orthopaedic Transactions sponsored by Journal of Bone and Joint Surgery, Vol. 1, No
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