Medical Records
Authorization to release protected health information Authorization Forms You may call the phone numbers below for help submitting your form. Please note: Staff at these numbers will not share your information verbally. Contact List Fairview Clinics Fairview Lakes Medical Center Fairview Northland Medical Center Fairview Ridges Hospital Fairview Southdale Hospital University of Minnesota Medical Center, Fairview East Bank campus
To request the release of your private health records, please download and fill out one of the authorization forms below. Then, call the site where you received treatment to ask how you should submit the form. For contact information, see the list below.
Call the site (see clinic list)
Health Information Management
5200 Fairview Blvd., Wyoming, MN 55092
Phone: 651-982-7870; Fax: 651-982-7122
Health Information Management
911 Northland Dr., Princeton, MN 55371
Phone: 763-389-6522; Fax: 763-389-6545
Health Information Management
201 East Nicollet Blvd., Burnsville, MN 55337
Phone: 952-892-2000; Fax: 952-892-2024
Release of Information, LL25
6401 France Ave. S., Edina, MN 55435-2199
Phone: 952-924-1414; Fax: 952-924-8443
University of Minnesota Amplatz Children's Hospital
West Bank campus
Health Information Management office: 612-273-4370
Release of Information Contact:
2450 Riverside Ave., Minneapolis, MN 55454
Phone: 612-273-4359; Fax: 612-273-4069
Health Information Management office: 612-626-3535
Release of Information Contact:
420 Delaware Street SE, MMC 601, Minneapolis, MN 55455
Phone: 612-626-3238; Fax: 612-273-2345
