Print, complete and mail the form and copy of photo ID to: Health Information Management Union Hospital. 659 Boulevard. Dover, OH 44622. Or you may fax the completed form and a copy of your photo ID to 330.364.0868. For questions or for more information, call 330.343.3311, ext. 2326 during office hours, Monday - Friday, 7 a.m. - 5 p.m..