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Authorization to Disclose Protected Health Information

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Please fax your completed form to MDI Hospital’s Health Information Management Office at 207 288-8119. Or you may mail it to Mount Desert Island Hospital, 10 Wayman Lane, Attn: HIM Department, Bar Harbor, ME 04609.

In order to protect your personal health information, we ask that you do not submit this form through email.

Click here to download the Authorization Form.