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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