Forms

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.

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.

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.