Mahnomen Health Release of Information is dedicated to protecting the privacy and security of your health information while ensuring it’s availability for continued medical care, payment, personal needs, medical records or other appropriate uses.
Your medical record contains information regarding your personal health. This includes immunizations, allergies, hospitalizations, medications, diagnoses, treatments and health history.
Requesting Health Information
We are committed to protecting the privacy and security of your health information therefore Mahnomen Health will only release information with your consent and in accordance to State and Federal Regulations. In some cases, fees may apply.
Release of Information Authorization Form
To obtain a copy of your medical records, download and print a copy of our Authorization for Disclosure of Protected Health Information form. Fill the form out as completely as possible. Missing information may delay the response to your request.
Authorization forms may be returned to the Health Information Department at Mahnomen Health. Forms may be received by contacting us as directed below.
Frequently Asked Questions
Who is authorized to sign for release of medical records?
You must be 18 years of age or the parent/legal guardian to request copies of your medical record.
The authorization must be signed by the patient, a parent if the patient is a minor, or the patient’s legally empowered representative.
Who is authorized to sign for release of medical records if the patient is deceased?
For a deceased patient, the authorization must be signed by the appointed personal representative. A responsible next of kin, including a surviving spouse, an adult child, or a parent, may also authorize release of records.
Who can pick up medical records?
If someone other than the patient will be picking up copies of medical records, please let us know in advance. The person picking up the medical records must bring written authorization from the patient. Personal identification is required for all pickups.
- Fax: 218-216-1922
- Email: [email protected]
414 W Jefferson Ave
Mahnomen, MN 56557
Note: Mahnomen Health Hospital utilizes My Chart via Sanford Health. Most of your health record may be accessed and viewed online through the portal. To enroll, visit My Sanford Chart to create a free account.