Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Massachusetts General Hospital (MGH) before sending sensitive documents. FaxFlow is not affiliated with this organization.
Massachusetts General Hospital (MGH) fax number
(617) 724-0264
Release of Information – Radiology/Imaging
Used for: Requests for copies of radiology images/films and release of protected health information
Fax destination details
- Department
- Release of Information – Radiology/Imaging
- Purpose
- Requests for copies of radiology images/films and release of protected health information
- Form
- Authorization for Release of Protected Health Information — AUTHORIZATION FOR RELEASE OF PROTECTED OR PRIVILEGED HEALTH INFORMATION
- Address
- 121 Inner Belt Road, Room 240, Somerville, MA 02143-4453
- Voice phone
- 617-726-2361
- Website
- Visit organization website
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.
Complete sections A–E (patient and recipient details, purpose, items to be released, and authorization). For radiology images, include the specific dates and imaging types; sign and date; the authorization expires 6 months from the date signed unless otherwise specified.
Review official form instructionsSources and verification
FaxFlow records the public sources found during directory research. A source link is useful evidence, but it is not a guarantee that a number still reaches the same team.
No public source link was saved with this record. Confirm the number directly with the organization before using it.