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Medical Records

To receive a copy of your medical records:

Please complete and sign an Authorization to Release Protected Health Information form. Please allow five to ten days to process your request.

The completed hospital authorization form can be faxed to 508-427-2209 or 508-427-2291. You may also mail it to: 

Health Information Services Department (Address to Radiology Department if ONLY needing a copy of an image on CD)
Attention: Correspondence Unit at Good Samaritan Medical Center
235 N. Pearl St.
Brockton, MA 02301

For questions, please call the correspondence unit at 508-427-3180 during the following times:

  • Monday - Friday: 8 a.m. - 5 p.m.