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Fax Medical Records from Home Without A Fax Machine - FaxCompare

Fax Medical Records from Home Without A Fax Machine - FaxCompare 2026

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The document is an Oncology CT - MR Fax Form used for non-urgent requests for imaging related to oncology. It requires detailed patient and provider information, including medical history, diagnosis, and treatment plans. The form emphasizes the importance of providing complete information to avoid delays in authorization and includes a confidentiality notice regarding HIPAA regulations.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Ordering Provider' section. Enter the first name, middle initial, date of birth, gender, and contact information including home and cell phone numbers.
Next, complete the 'Patient/Member' section with the patient's details such as health plan, member ID, and group ID.
In the 'Clinical Information' section, provide details about the diagnosis, including CPT and ICD-10 codes. Be sure to answer questions regarding previous treatments and current symptoms.
Finally, review all entries for accuracy. Once completed, save your document and use our platform to securely send it without needing a fax machine.

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