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Your health information/medical records are very important to us and we are able to share your official health information when you submit a Release of Health Information.

Release of Health Information

Copies of medical records can be requested and obtained through Codman Square Health Center's Health Information Management Service (HIMS) Department.

How do I get copies of my medical records?

To get copies of your medical record, you must fill out a release of information consent form. The request must be completed and returned to HIMS Department. 

All requests must be in writing. You may mail or fax a written request, which must contain the following elements to assist us in identifying your record(s). The written request must include:

-A legible copy of a Government Photo ID, such as a valid driver's license, State issued ID, Passport or Military ID.
-Patient's full name (previous name (s), date of birth, address, and social security number)
-Name of recipient, address, phone number (who is to receive information)
-Type of information requested (exact information you want released)
-Purpose of release (what information is being requested)
-Approximate date of treatment 
-Appropriate signature with witnessed signature 
-Date of request
-Expiration date of request (not to exceed one year from date of request)

All requests can take up to 30 days to complete, however the HIMS department will try to complete the request within 14 days.

When you sign up for MyChart, we'll give you online access to select healthcare records, 24 hours a day, 7 days a week.

Telephone Number: 617-822-8253 or 617-822-8353
Fax to: 617-825-3663
Hours of Operations: Monday-Friday, 8:30am-5:00pm

You can also mail all written requests to:
Health Information Department 
Codman Square Health Center
637 Washington Street 
Dorchester, MA, 02124 

Note: A fee is not assessed for copies of medical records for continuity of care (physicians or hospitals).  However, copies of records for reasons other than continuity of care are subject to a copy fee. These include but are not limited to, legal requests, investigative agencies, insurance companies, etc. If you have any questions, please contact the Health Information Management Service Department.

Authorize the Release of Protected Health InformationClick here for the Release Form to Authorize the Release of Protected Health Information (PHI)