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Legal Forms
Use the forms below to assign or remove representatives who can make healthcare decisions for you or decide who can see your personal health information.
Legal
Type
Title
Language
Care Needs Screening
English
Form - Allow Boston Medical Center to Obtain Protected Health Information
English
Form - Allow Care Management to Obtain Protected Health Information
English
Form - Assign a Healthcare Proxy
English
Form - Assign an Appeals Representative (MassHealth)
English
Form - Assign a Personal Representative
English
Form - Remove a Personal Representative
English
Form - Request for Access to Information
English
Form - Request for Confidential Communication
English
Form - Request to Release Information
English
Form - Revoke Release of Information
English
Fòmilè Otorizasyon Jesyon Swen ESP
Haitian Creole
Formulário de autorização de PHI para gestão de atendimentos
Portuguese
Formulario de autorización de PHI para
Spanish
Formulario de solicitud de designación de representante personal
Spanish
Formulario de Autorización de PHI para Administración de la Atención
Spanish
Formulario de Autorización de Representante para Apelación
Spanish
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