PHI Release Authorization

To request your medical records, print and complete the Authorization for Release of Protected Health Information (PHI) and fax, email or mail it to FastMed. Please note appropriate state's fax number or address for your specific request when faxing or mailing the form.

pdf Authorization for Release of Protected Health Information

Fax: 919.882.9502

Email: MedicalRecords@FastMed.com

Mail:
935 Shotwell Rd.
Ste. 108
Clayton, NC 27520