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I-Fax

I-Fax is a program that allows providers to receive discharge summaries and other clinic notes via fax instead of postal mail. You must have a confidential and readily available fax device in order to participate in the program.

Fill out the on-line form below and click submit.

You will receive a telephone call from a physician liaison at University of Iowa Health Care confirming receipt of the form. If you have any questions, please contact the Office of Referring Physicians at 319-384-6103 or via e-mail at referring-physician@uiowa.edu.

*Contact's First Name   Last name
Contact's Telephone (Voice)  
Referring Physician's First Name   Last name
Primary Clinic Name  
Primary Clinic Address  
Primary Fax Number  
**Additional Clinic Name  
Additional Clinic Address  
Additional Fax Number  

* If physician would prefer to have someone besides themselves contacted regarding verification (i.e. an assistant, a clinic manager, clinic administrator, etc.) please include that person's contact information here.

** If physician has more than one practice location (i.e. outreach clinics, multiple hospital privileges, etc), additional information can be submitted here.

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Last modification date: Tue Mar 20 12:06:43 2007
URL: https://wws.uihealthcare.com /depts/strategicrelations/ifaxform.html