Your privacy matters to us. We are committed to ensuring that your medical record remains confidential. We will only release them in accordance with applicable laws.
Your medical record includes essential 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. Below you will find several forms that we maintain in medical records that may be relevant to your care and your situation.
If you have any questions or need a copy of your medical record, please call us at 320.225.3501 to speak with one of our Health Information Specialists.
A health care directive is a written document that informs others of your wishes about your health care. The Minnesota Board on Aging (MBA) offers an introduction.VISIT MBA (external link)
Assignment of benefits
Authorizes direct billing and payment from your insurance company, informs you of your rights, and indicates acceptance of financial responsibility for medical expenses not covered by insurance.DOWNLOAD FORM (PDF)
Request medical records
This form allows a patient to give authorization to a third party to access their health records.DOWNLOAD FORM (PDF)
Release of information
Authorizes sharing of information with payers or providers involved in your care for purposes of treatment, payment and healthcare operations, and the search of medical records by third parties for research purposes.DOWNLOAD FORM (PDF)
Discussion of information
Authorizes verbal discussions of scheduling, medical and billing information with designated individuals.DOWNLOAD FORM (PDF)
Electronic health records
Authorizes consolidating your medical records so your providers who use the same electronic health record system may access the most up-to-date information about your care and treatment.DOWNLOAD FORM (PDF)