Your privacy matters to us. We are committed to ensuring that your medical record remains confidential. We will only release them in accordance to applicable laws.
Your medical record includes important information such as your medical history, allergies, medicines and test results, health insurance information and contact details. To request access to your medical records, you need to complete and submit a release form. If you have any questions or you need a copy of your medical record, please call us at 320.225.3501 to speak with one of our Health Information specialists.
Below is a list of forms that we maintain in medical records that may be relevant to your care and your situation.
A healthcare directive is a written legal document that informs persons of your health care wishes or names a person to make decisions on your behalf, if you become unable to make your own decisions.
- Healthcare Directive (2-page)
- Healthcare Directive (4-page) and Guide
- Healthcare Directive (8-page) and Guide
Assignment of benefits
This form authorizes payment directly to the provider for services provided by Welia Health (physicians, contracted providers, or providers participating in the Welia Health network).
Consent for release of information
This form authorizes the release of information to locators, payers, payers and networks, healthcare providers, and medical records research.
Consent for combining heath records among healthcare providers
This form authorizes the sharing of health records through your electronic health record (EHR) to coordinate your care and exchange information about your treatment(s).