Send a standard request letter to:
121 Inner Belt Road
Somerville, MA 022143-4453
Include hospital record number (also known as patient identification number and the
patient unit number) located on the blue patient card (also referred to as the ID,
hospital card, or plastic card). If unavailable, also provide:
Full name and address at time of admission (if different from present)
Dates of admission and discharge
Name of claimant’s medical source(s).
NOTE: For information about impairments of the eye, ear, nose, and throat, send the request
to the Massachusetts Eye and Ear Infirmary.