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617-730-0327, or mailed to:-2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the Demographics section. Enter the Patient's Last Name, First Name, Middle Initial, Home Address, City, State, Zip Code, and contact numbers.
- In the Authorization section, specify who will receive the medical records by entering their Name/Facility and contact details.
- Select the Purpose of Release by checking the appropriate box for Medical Care, School or Camp, Insurance, Personal, or Legal Matter.
- Choose the Format of Release by checking either CD, Paper, Fax (to MD Office only), Electronic or Other.
- Indicate the Information Requested by specifying a Date Range and selecting from options like Entire Medical Record or Medical Record Abstract.
- On Page 2, initial next to each type of information you authorize for release and provide your signature along with the date.
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617-730-0327, or mailed to: HIM/Medical Records. Boston Childrens Hospital. 300 Longwood Avenue. Boston, MA 02115. Please complete this form and sign on page 2Read more
Mailing Address: Attn.: Medical Records 300 Longwood Ave. Boston, MA 02115. Fax: 617-730-0327 or 617-730-0329. Charges for copies. There is no charge forRead more