Mass general hospital medical records release form 2026

1. Click ‘Get Form’ to open the mass general hospital medical records release form in the editor.
2. Begin by filling in your personal information. Enter your last name, first name, date of birth, and medical record number in the designated fields.
3. Provide your contact details including email, street address, apartment number (if applicable), city, state, zip code, and telephone numbers for day and evening.
4. Authorize the release of your protected health information by entering your name as the patient or legal representative. Specify the individuals or facilities you wish to receive this information.
5. Indicate the purpose for which you are requesting this information by checking the appropriate box (e.g., Medical Care, Insurance).
6. Select all types of information you wish to be released by checking the relevant boxes and specifying dates where necessary.
7. Answer 'Yes' or 'No' to questions regarding specifically protected information such as HIV test results or mental health records.
8. Review your entries for accuracy before signing. Once completed, print and sign on page 2 where indicated.
9. Fax the signed document to 617-726-3661 as instructed.

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