Masshealth casualty recovery unit 2026

1. Click ‘Get Form’ to open the MassHealth Casualty Recovery Unit Permission to Share Information (PSI) form in the editor.
2. In Section 1, enter the name of the MassHealth member and their contact details, including street address, city/state/zip, date of birth, telephone number, and MassHealth ID number. If no ID is available, use the social security number.
3. Move to Section 2 and specify what information you want shared by checking the appropriate boxes. Be mindful that this may include financial information.
4. In Section 3, provide the name of one person or organization you wish to share information with. Ensure all contact details are accurate.
5. Section 4 requires you to explain why you want your information shared. If left blank, it will be assumed as 'at my request.'
6. Complete Section 5 by specifying an end date for permission if desired; otherwise, it will last for 18 months.
7. In Section 6, sign and date the form. If someone else is filling it out on behalf of the member, complete Section 7 with their details and authority.

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