Directory information — verify before you send. This fax number was compiled by automated research from public sources. It may be out of date, incomplete, incorrect, or in rare cases wrong entirely, and it is not confirmed by Massachusetts General Hospital (MGH). Before sending anything sensitive, confirm the number and receiving department directly with Massachusetts General Hospital (MGH), and consider sending a test cover page first. FaxFlow is an independent directory, is not affiliated with, endorsed by, or sponsored by this organization, and accepts no liability for reliance on this listing.
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Massachusetts General Hospital (MGH) fax number
(617) 724-0264
Wrong or outdated? Report this number
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
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