Signature Healthcare
Medical Records Request:
Patients have the right to review or receive copies of their medical records upon request. To obtain a copy of your medical records you may choose one of the following two methods:
Patients requesting records to be sent to another provider or healthcare facility for continuity of care will not incur a charge. A charge will be incurred if a patient requests records for personal use. Once the record has been retrieved, the Health Information Department via Ciox the release of information vendor will provide an invoice. You may cancel the request by following the instructions on the invoice.
Please contact the Health Information Management Department (HIM) with any questions: 508-941-7069.
If you wish to fill-out a paper form to request your records, please click here. Once completed, please fax the form to 478-246-4175 or mail it to:
Signature Healthcare
Attn: Health Information Management
680 Centre Street
Brockton, MA 02302
Request for Medical Images:
If you wish to obtain a copy of images from a Radiology exam (X-Ray, Ultrasound, CT, Mammogram, Etc.), please complete the Authorization of Release of Medical Images form below.
There is no charge for personal copies of images or to send directly from Signature Healthcare to another provider. There will be a fee if images are requested for legal cases. Once the images have been retrieved, the Radiology Department will provide a quote of what it would cost for the images and you will then have the opportunity to choose to go forward with the request and pay the charge or cancel your request.
All requests must be sent via the form, we cannot accept requests via email or phone. Please contact the Radiology Department with questions: 508-941-7150
Once completed please return the form via mail or fax:
Mailing Address:
Signature Healthcare
Attention: Radiology Department
680 Centre Street
Brockton, MA 02302
Radiology Fax: 508-941-6159 (This number is for faxing Radiology Image requests only).