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Massachusetts General Hospital Medical Records Release Form. Mail or Fax to: Release of Information. AUTHORIZATION FOR RELEASE OF PROTECTED OR PRIVILEGED HEALTH INFORMATION. 121 Inner Belt Road, Room 240 Somerville, MA 02143-4453 Phone: 617-726-2361. FAX: 617-726-3661. For copies of radiology images or films, contact 617-726-1798 / Fax 617-724-0264
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.
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."
Patient Confidentiality. Massachusetts General Hospital adheres to the requirements outlined by the Health Insurance Portability and Accountability Act (HIPAA), which ensures security and privacy of an individual's medical records and promotes privacy and trust between patients and their health care providers. As part of HIPAA requirements, all ...
NOTE: Sending your medical records through email is not a secure method and may put your medical records and personal information at risk. TO REQUEST THE RELEASE OF SPECIFICALLY PROTECTED OR PRIVILEGED INFORMATION, YOU MUST INITIAL BELOW: _____ HIV Test Results (PATIENT AUTHORIZATION REQUIRED FOR EACH RELEASE REQUEST).
A. Health and Personal Information. Please describe the information you want the. to share about you. (Fill in name of person or organization) Please include any dates and details you want to share. B. Permission about Specific Health Information. Only if you choose to share any of the following information, please write your initials on the line:
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
