Center for Health Information and Analysis
Public Records Request Form
Email or mail completed form to: Center for Health Information and Analysis
Public Records - Corine Peach
501 Boylston Street, Boston, MA 02116
Email: public.records@state.ma.us
Phone: (617) 701-8105
Please note: CHIA fullls public records requests by releasing data in the form in which it is currently held by
CHIA. CHIA does not perform individualized analyses nor does CHIA tailor the format or presentation of data
in response to specic inquiries.
Please check the type of record(s) you are requesting:
Cost Report:
Adult Day Health
Community Health Center
Hospital
Nursing Facility (HCF-1)
Nursing Facility Realty Company (HCF-2)
Nursing Facility Management Company (HCF-3)
Nursing Service Report
Resident Care Facility (HCF-4)
Database:
Nursing Facility Cost Report Data ($25.00)
Hospital and Other Provider Financial Statements
Charge Book (Hospital)
Regulations/Public Hearings/Testimony
CHIA
center
for health
information
and analysis
Date:
Other (Please Specify)
To request multiple records, please list records in alphabetical order and specify year
(attach additional sheet if necessary):
1.
2.
3.
4.
5.
Contact Name Company
Address City State Zip
E-mail Phone
