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Representative is usually the person filling out this form. Provide Area Code with each fax number.



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Partial Results Finals Only. LabCorp strongly encourages all clients to physically safeguard fax machines, so that the location, access, and use of such machines comply with all HIPAA requirements.



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Representative is usually the person filling out this form.

Representative is usually the person filling out this form. LabCorp strongly encourages all clients to physically safeguard fax machines, so that the location, access, and use of such machines comply with all HIPAA requirements.


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  1. The undersigned health care provider may revoke this authorization or change the fax number, provided that the undersigned health care provider gives LabCorp reasonable written notice. LabCorp strongly encourages all clients to physically safeguard fax machines, so that the location, access, and use of such machines comply with all HIPAA requirements.