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Mass General Brigham Release of Information Unit (Partners HealthCare) fax number

(617) 726-3661

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Release of Information

Used for: Medical records release / Release of Information requests

Fax destination details

Department
Release of Information
Purpose
Medical records release / Release of Information requests
Form
Medical Records Release Form — Medical Records Release Form (Authorization for Release of Medical Records)
Address
121 Inner Belt Road, Somerville, MA 02143-4453
Voice phone
617-726-2361

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Fill in patient information, purpose of disclosure, and recipient details; sign and date; fax the completed form to 617-726-3661 or submit via the designated ROI channel.

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