Please use our Authorization to Communicate and Obtain PHI form.
English | Haitian Creole | Portuguese | Spanish
This lets CHA communicate with or obtain medical records from other providers and healthcare organizations.
You can print these forms and fax or mail them to us
Health Information Management (HIM) Department
- Main Phone: 617-381-7126
- Fax: 617-381-7179
- Mailing address: 103 Garland Street Everett, MA 02149