Authorization to Release Patient Information
IMPORTANT: Please be aware that not all personal emails are secured. For this reason, due to Federal HIPAA* regulations please do not include personal health information in your correspondence.
A patient, or his/her legal representative, may inspect and/or obtain a copy, request an amendment or have copies of medical records sent to another facility. United Hospital District requires a completed and signed authorization for release of health information form before releasing any documents.
To request a copy of your medical record:
Download, print and complete the Authorization for Release of Information form below:
We ask that you specify which components of your medical records you wish to obtain. Please indicate on the form how you would like to receive the records. They can be mailed to you or you can pick them up.
Release of Information Fax: 507-526-2467
Release of Information Phone: 507-526-7981
If you have any other questions or concerns regarding release of health information, call 507-526-7981.
*Health Insurance Portability and Accountability Act (HIPAA) protects the security and privacy of health data.