Medical Records/Health Information Management

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:

  • If the client/patient is a minor (under the age of 18), the authorization must be signed and dated by a custodial parent or Guardian.  If an authorization is signed by a Guardian, the request letter and authorization must be forwarded to the Health Information Management Department accompanied by copies of court documents appointing the signer as guardian
  • If the client/patient is an adult and has a guardian, the signed and dated Authorization must be forwarded to the Health Information Management Department accompanied by court documents appointing the signer as guardian
  • If the client/patient is an Adult (over the age of 18) then only the client/patient may legally sign the authorization


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
72 Jaques Avenue
Worcester, MA 01610


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.

 

Community Healthlink, Inc. • 72 Jaques Avenue, Worcester, MA 01610-2480 • Phone: 508-860-1000

Copyright (c) 2018 Community Healthlink: Making a difference in someone's life...every day!
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