Authorization to Disclose Protected Health Information

Please fax your completed form to MDI Hospital’s Health Information Management Office at 207 288-8119 or 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

MDI Hospital

MDI Hospital
17 Hancock Street
Bar Harbor, ME 04609
207 288-5081

At Mount Desert Island Hospital, we provide comprehensive care for you and your family through our hospital in Bar Harbor and a network of health centers across Mount Desert Island.