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MassHealth will send you back a copy of this signed Medical Records Release Form for you to keep for your records. You can also request another copy of this signed Medical Records Release Form at any time by contacting MassHealth at the following address. You can do this by filling out a MassHealth Eligibility Representative Designation Form ERD. To request an ERD form call MassHealth Customer Service at 1-800-841-2900 TTY 1-800-497-4648 for people with partial or total hearing loss. Be sure to sign and date each form. These release forms are at the end of this packet. If you need more copies of the Medical Release Form call a MassHealth Enrollment Center at 1-888-665-9993 TTY 1-888-665-9997 for people with partial or total hearing loss or download the form at www. Print type or write clearly and complete the supplement to the best of your ability. Sign and date a Medical Release Form for each medical and mental health provider you list on the supplement. After you have filled out the ....

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232