Release of Medical Information

Be sure to complete all blank areas and sign and date on page 2.

Download our Authorization to Release Healthcare Information Form

Mail to:
Health Information Services
Northern Light CA Dean Hospital
PO Box 1129
Greenville, Maine 04441

Fax to: 207-695-2254

Remember…If you want records on any patient; other than yourself, you must contact our department for further instructions on what may be needed.

Please feel free to call us at (207) 695-5225

Health Information Services