Concord Hillside Medical Associates
Forms
Medical History Forms
Tell us about yourself – fill out this form and bring it with you to your appointment.
- Travel Medicine Form (pdf)
Release of Information Forms
- Authorization for Release of Information to Harvard Vanguard Medical Associates (pdf) updated 3/2009
Use this form if you require release of partial or full information from another organization to Harvard Vanguard. This form requires a patient/parent and/or legal guardian's signature. Please print and complete this form and return to Concord Hillside Medical Associates for processing.
- Authorization for Release of Information from Harvard Vanguard Medical Associates (pdf) updated 3/2009
Use this form if you require release of partial or full information from your medical records.This form requires a patient/parent and/or legal guardian's signature. Please print and complete this form and return to Concord Hillside Medical Associates for processing.
- Verbal Disclosure (pdf)
This form is used to authorize the verbal communication of your care and treatment with an identified family member, friend or caregiver. The completed form should be mailed or faxed to the address/fax number noted at the top of the form. For any questions, please contact the ROI department at 978-287-9423.
Miscellaneous Forms/Healthcare Decisions
- Health Care Proxy Form (pdf)
The Massachusetts Health Care Proxy is a simple legal document that allows you to name someone you know and trust to make healthcare decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions.
- Advance Directives Form (pdf)
Caring Connections: Massachusetts Advance Directive- Planning for Important Healthcare Decisions
Medical Records
To off-set the costs associated with producing medical record copies, it has become necessary to ask for payment BEFORE each request can be processed. Details are contained in this document.
