Use the links below to access frequently used/requested forms.
Medical Records Release Forms
- Authorization for Release of Information from Atrius Health
Request that Atrius Health release copies of your medical record to yourself, another healthcare provider, or third-party.
- Authorization for Release of Information to Atrius Health (New Patients: Internal Medicine and Family Medicine Only)
Request that another healthcare provider release your medical information to Atrius Health internal medicine or family medicine.
- Authorization for Release of Information to Atrius Health (All Other Specialties)
Request that another healthcare provider release your medical information to Atrius Health.
Radiology Films/Images Release Forms
- Authorization for Release of Radiology Films/Images
Request that Atrius Health release your Radiology films/images to the another person/facility.
- Authorization to Obtain Radiology Films/Images
Request that another healthcare provider release your Radiology films/images to Atrius Health.
Health Care Proxy
- Massachusetts Health Care Proxy
Do you need to name someone you know and trust to make health care decisions for you?
Authorization for 3rd Party Release
- Authorization for Release of Protected Health Information to A Third-Party
A request for your clinician to complete a letter or a form regarding your medical information to be sent to someone other than yourself. For example, give this form to your clinician if you are applying for FMLA and your employer requires information about your medical condition.
Please note: This form is not needed if your medical information is given directly to you as the patient.
