DialClerk Directory

Main Line Health

Records, fax and other contacts

Find other published document channels. Confirm the department and purpose before sending any records.

fax other

Patient billing — disclosure of PHI to family/personal representative form

Official page read
Phone

No phone listed for this route

Fax

484-337-1436

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address
Main Line Health Attn: Customer Service Patient Billing Department 3803 West Chester Pike, Suite 160 Newtown Square, PA 19073

Billing PHI disclosure forms

Mail or fax the Disclose Protected Health Information form to Attn: Customer Service Patient Billing Department (secure office; no drop-off).

View source ↗ · Source checked 2026-10-25

Report an update

fax other

Health information management / medical records release

Official page read
Phone

No phone listed for this route

Fax

610-356-3167

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address
Health Information Management Main Line Health 3803 West Chester Pike, Suite 160 Newtown Square, PA 19073

Medical records requests

Authorization for Disclosure of Health Information forms by mail, email or fax; records released only to recipients authorized in writing.

View source ↗ · Source checked 2026-10-25

Report an update

fax other

Health information management — PHI amendment requests

Official page read
Phone484-476-1721Fax

610-356-3531

Published hours

Not published in this record

Product, plan and location

Confirm the exact product or service
Pennsylvania

Mailing address

Not researched for this route

Requests to amend PHI/medical record (form by fax or mail). The page prints the ZIP as 1907; full ZIP 19073 appears elsewhere on Main Line Health pages for the same address.

View source ↗ · Source checked 2026-10-25

Report an update
Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

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Call preparation · editorial guide

Make the call count.

Find other published document channels. Confirm the department and purpose before sending any records.

Have ready in your secure workspace

  • Recipient department and exact document request
  • Required release or authorization
  • Secure return contact and existing request reference

Questions to resolve

  • Is this the correct destination for this document type?
  • Is there a secure portal or required form?
  • How is receipt confirmed?

This is a general administrative checklist, not payer policy or advice about a particular patient. Confirm the current plan instructions.

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