Community Healthlink's Medical Records/Health Information Management department handles all requests for the release of medical record information.
Any request for the release of information must include a complete signed and dated Authorization for the Disclosure of Protected Health Information Form, which is available below:
Authorization for the Disclosure of Protected Health Information (English)
Authorization for the Disclosure of Protected Health Information (Spanish)
Authorization for the Disclosure of Protected Health Information (Portuguese)
Authorization for the Disclosure of Protected Health Information (Albanian)
Authorization for the Disclosure of Protected Health Information (Vietnamese)
Authorization for the Disclosure of Protected Health Information (Arabic)
Authorizations for release of information must be signed and dated by the following parties:
Once the authorization form is complete, it can be sent to us in one of two ways:
Via Mail:
Health Information Management Department
Community Healthlink
199 Chandler Street
Worcester, MA 01610
Phone: 508-860-1016
Via Fax:
508-752-1379
If you have questions or need further information, you can reach the Director of Medical Records/Health Information Management by phone at 508-860-1042.
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