Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Holyoke Medical Center before sending sensitive documents. FaxFlow is not affiliated with this organization.

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Holyoke Medical Center fax number

(413) 534-2618

Attention Dept. (Medical Records / Health Information Management)

Used for: Release of health information / medical records

Fax destination details

Department
Attention Dept. (Medical Records / Health Information Management)
Purpose
Release of health information / medical records
Form
HIPAA Authorization — AUTHORIZATION TO USE AND DISCLOSE PROTECTED HEALTH INFORMATION
Address
575 Beech Street, Holyoke, MA 01040
Voice phone
(413) 534-2500

Before you send

  • Confirm that this exact department handles your document or request.
  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
  • Keep the delivery confirmation with your submission records.

Fill in patient name, date of birth, and medical record number; indicate what to release (e.g., entire record, abstracts, labs, radiology, etc.); specify dates of service; state the purpose (continuity of care, legal, personal, etc.); sign and date; note expiration; and acknowledge rights described in the form (e.g., potential restrictions for HIV/genetic/drug treatment records).

Sources and verification

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