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Mail or Fax Release Form To: Release of Information 121 Inner Belt Road, Room 240 Somerville, MA 02143-4453 Fax: 617-726-3661 For questions, contact: 617-726-2361. For copies of radiology images or films, contact (617) 726-1798 / Fax (617) 724-0264. Title. Massachusetts General Hospital Medical Records Release Form. Created Date.
Check here if the records are to be mailed to the patient at the above address (section A), otherwise complete the information below to indicate where you would like the information sent: Partners Patient Gateway (if available) Secure Email (provide email address below) Patient Email Address: Paper Copy via Mail Fax (provide fax number): SEND ...
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People also ask
Do I need an authorization to send records from one HealthPartners facility?
How do I send health information from one HealthPartners facility to another?
How do I request records to be sent from a HealthPartners facility?
Are the medical records offices available for patient walk-in services?
Partners Patient Gateway (if available) Secure Email (provide email address below) Patient Email Address: Paper Copy via Mail Fax (provide fax number): C. INFORMATION TO BE RELEASED (Please check all that apply, and specify dates): Medical Record Abstract/dates (e.g. History & Physical, Operative Report, Consults, Test
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Request patient medical records online. You can use Patient Gateway, our secure, online portal for your health information. Your health information is available to view, download, transmit, and print documents. Once logged in, click on "Menu" at the top bar and then click "Request Records."
HIPAA Authorization for Release of Protected or Privileged Information Author: Massachusetts General Hospital. Subject: This form can be used to request release of copies of health/medical record, review of health/medical records, or to obtain copies of health/medical records from another facility. Keywords: HIPAA authorization Created Date
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Release method: This tells us how you would like your information delivered. Entering a date ensures that your records will be available when you need them. Multiple electronic delivery options are available (e.g., email, online patient portal). If an email option is chosen, you may receive an email from the organization’s copy service vendor.
Contact our team for help with any questions or concerns about the release of medical records, itemized billing requests, and more. Medical records and itemized billing requests. You can also request your records by filling out this form.
