Costco Health Centers Privacy Office: Authorization for Release of PHI
Return the completed authorization required for this account or service.
Find Costco’s health information release fax and the separate Mail Order Pharmacy customer-service fax.
Return the completed authorization required for this account or service.
Order or account documents requested by the mail-order pharmacy.
For a release of protected health information, use the Privacy Office route and its authorization form. The Mail Order Pharmacy customer-service line serves a different purpose. A patient should not assume either is an authorized route for submitting a new prescription.
Submit the signed disclosure authorization for records access. Send mail-order account or order correspondence only as the pharmacy requests, using its current ordering instructions.
Name the receiving department and the hospital, clinic or service involved. Add the document title, page count and a callback number. Put patient identifiers and authorization details in the fields the official form requests; a cover page does not replace signed consent.
Open the official source above and check the current instructions. A reviewed source confirms a published number, not live availability. Toll-free numbers can still incur sending-service or international charges.
Keep the transmission result and a copy of the documents. Confirm with the receiving department that the packet is complete and can be processed; a delivery receipt does not establish acceptance or a decision. These are fax destinations, not voice support lines. Check with Costco Pharmacy before sending a duplicate.
Prepare a legible PDF, confirm the department and number, and review all pages before authorizing the fax. With DearFax, you can send online or prepare a workflow through ChatGPT, Codex and MCP. Save the transmission result with your records.
Healthcare organizations should confirm their compliance requirements before selecting a fax service. DearFax does not currently offer HIPAA compliance.
Frequently asked questions