Download and complete the authorization for release of medical information form (see forms)
Mail, fax or deliver this form in person:
- Mail: UVA Health System Release of Information, Health Information Services P.O. Box 800476, Charlottesville, VA 22908
- Fax: (434) 924-2432
- Deliver: 1222 Jefferson Park Ave, first floor
The authorization will be valid for 12 months from the date of signature.
QUESTIONS? NEED HELP? CALL US AT 434.924.5136