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Nurse Filling Out Form

PATIENT FORMS

Below, find links to common forms that you can print and complete as needed. If you need any help, please call 603-626-9500.
Filling out form vector art

Your medical record is considered Protected Health Information (PHI), which means that it's covered by health privacy laws; we always need your written permission to release it. As a patient of Amoskeag Health, you are protected by a set of rules and regulations called your "Patient Bill of Rights."

You can always view pieces of your medical record, like recent test results, on the Patient Portal. However, if you need more information than what you can see in your account, you can request a copy through the Release of Information/Authorization for Disclosure of Health Information form below. There is no charge to send your medical record to a hospital or another physician.

If you want to authorize someone like a spouse or relative to have access to your medical records, you may fill out the Authorized Representative Consent Form below.

Accessing Your Medical Records
Release of Information/Authorization for Disclosure of Health Information
Mail Completed Forms to:​

Medical Records

Amoskeag Health

145 Hollis Street

Manchester, NH 03102

Or, fax 833-448-1486.
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