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Release of Information (ROI) Forms


Please download, complete and sign the form and send to Health Information Management (HIM). To complete them on your computer, download and save the PDF, then open with Adobe Reader. (Learn how to complete an authorization form.)

Care Everywhere®

Contact Us 

Health Information Management Release of Information
601 Elmwood Ave., Box 616 
Rochester, NY 14642 

Phone: (585) 275-2605 
Monday—Friday, 9 a.m.—4 p.m. 
Fax: (585) 273-1257