Forms
Below is a list of some frequently used forms which you may find useful. Click on a link to open, save, and print the form.
Requesting Medical Records
- Release of PHI (Protected Health Information) - Request copy of medical records
- Designation of Personal Representative/Proxy
After completing either the Release of PHI form or the Designation of Personal Representative form, please Fax to (603) 354-5478 or mail to:
Medical Records Dept.
Cheshire Medical Center
590 Court St
Keene, NH 03431
Business/Financial
Preparing For Your Visit
Medical Clearance
