Upstate university hospital fax form 2025

Get Form
upstate hospital directory Preview on Page 1

Here's how it works

01. Edit your upstate hospital directory online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out upstate university hospital fax form with our platform

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2
  1. Click ‘Get Form’ to open the upstate university hospital fax form in the editor.
  2. Begin by entering today’s date in the designated field at the top of the form.
  3. In the 'PRINT NAME OF SUBJECT' section, clearly write the name of the individual whose images are being authorized.
  4. If applicable, provide your job title or student status in the corresponding field.
  5. Sign in the 'SIGNATURE OF SUBJECT' area. If the subject is a minor, ensure a parent or guardian signs here as well.
  6. Fill out the 'PRINT NAME OF PARENT OR GUARDIAN' if necessary, along with their address and contact information.
  7. Complete any additional details such as hair color and clothing description if this is a large group shot.
  8. Finally, have a witness sign and date in the appropriate fields to finalize your consent.

Start using our platform today for free to streamline your document editing and signing process!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
Phone Directory Department namePhone number Main Phone 469.764.8000 Business Office/Billing Questions 214.820.2278 Medical Records 469.764.9110 | Fax: 469.764.9118 Physician Referral 1.844.BSW.DOCS (1.844.279.3627) (1.844.279.3627)2 more rows
To contact MUSC Health Information Services (Medical Records) in writing, the address is: 169 Ashley Avenue / MSC 349 /Suite 200/ Attention: Release of Information / Charleston, South Carolina 29425-3490; the phone number is (843) 792-3881; FAX NUMBER 843-876-8080 or 843-876-8055.
Please fax the form to (608) 267-8148. Once the fax is received, it will be reviewed and processed. We will contact you with any questions we have and will docHub out to the patient directly to schedule the appointment.
SUNY Upstate Medical University Ranking (2024) | Top Universities Institution NameSUNY Upstate Medical University World Rank 1044 out of 20,966 Percentile Top 5% in the world Regional Rank (USA and Canada) 242 National Rank 2157 more rows
FAX your completed Request for Airman Medical Records Form to (405) 954-9326.

People also ask

Fax completed form to 844.870.8875 If you are interested in receiving this periodic update, please complete the below requested information, sign, and fax the completed form to 1-844-870-8875.
Temple University Hospital Patients Phone: 215-707-3755. Fax: 215-707-6123.
Fax the completed form and a copy of your ID to the Medical Records Department at (855) 874-5286 or email the medical records department.

Related links