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Cooley dickinson hospital medical records 2025

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The document is an authorization form for the release of protected health information, requiring patient details and consent to share medical records with specified recipients. It outlines the types of information that can be released, the purposes for sharing, and includes sections for patient signature and legal representative if necessary. The form emphasizes patient rights regarding confidentiality and the voluntary nature of consent.

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Click ‘Get Form’ to open the Cooley Dickinson Hospital Medical Records in the editor.
Begin by filling out Section A, which includes your personal information. Clearly print your name, date of birth, medical record number, address, and contact numbers.
In Section B, provide details about where you want your health information sent. Specify the sender and recipient's names and addresses. Check the box if you want records mailed to your address listed in Section A.
Indicate the purpose for sharing your information by checking the appropriate box in Section B. This could be for medical care, personal reasons, insurance, etc.
In Section C, check all types of information you wish to release and specify any relevant dates. This may include medical records, lab reports, or radiology reports.
Complete Section D by indicating whether you authorize the release of sensitive information such as HIV test results or mental health records.
Finally, sign and date the form at the bottom. If applicable, a legal representative must also sign.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (131 Votes)
2018	4.1 Satisfied (68 Votes)

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How do I look up my hospital records?

How you make your request will depend on your providers processes. You may be able to request your record through your providers patient portal. You may have to fill out a form called a health or medical record release form, or request for accesssend an email, or mail or fax a letter to your provider.

How do I request medical records from Cooley Dickinson hospital?

The Medical Records Department can provide you with copies of your medical records related to care at a facility. The medical records offices are not available for patient walk-in services. If you need to collect records in person, please contact us at 617-726-2361 for possible options.

Can I walk into a hospital and get my medical records?

With limited exceptions, the HIPAA Privacy Rule (the Privacy Rule) provides individuals with a legal, enforceable right to see and receive copies upon request of the information in their medical and other health records maintained by their health care providers and health plans.