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Home > Customer Service > Authorization Form

Authorization for Use/Disclosure of Protected Health Information

Please fax/mail the signed authorization form to the following:

Mercy Medical Center
Attn: HIM dept.
271 Carew Street
Springfield, MA 01102


Fax: 413-452-6035
Phone: 413-748-9723


File Attachments
Authorization for Use Disclosure of Protected Health Information.pdf
For more information please feel free to contact us.


 
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