Medical Records

Authorization to release protected health information

Stock_TeenswithFriends02_LrgVert_FAN2012812To 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.

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
(see clinic list)
Health Information Management
4000 Central Ave.
Columbia Heights, MN 55421
Phone: 763-852-8850
Fax 612-365-0304  

Fairview Lakes Medical Center
Health Information Management
5200 Fairview Blvd., Wyoming, MN 55092
Phone: 651-982-7870; Fax: 651-982-7122

Fairview Northland Medical Center
Health Information Management
911 Northland Dr., Princeton, MN 55371
Phone: 763-389-6573; Fax: 763-389-6545

Fairview Ridges Hospital
Health Information Management
201 East Nicollet Blvd., Burnsville, MN 55337
Phone: 952-892-2060; Fax: 952-892-2024

Fairview Southdale Hospital
Release of Information, LL25
6401 France Ave. S., Edina, MN 55435-2199
Phone: 952-924-1414; Fax: 952-924-8443

University of Minnesota Health Maple Grove Clinics 
Health Information Management
14500 99th Avenue North Maple Grove, MN 55369
Phone: 763-898-1000; Fax 763-898-1009

Fairview Range 
Call the site (See list of clinics)

University of Minnesota Medical Center 
University of Minnesota Masonic 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

East Bank campus  
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  

View the release form for all sites.

Discrimination is Against the Law. We comply with applicable Federal civil rights laws. We do not discriminate against, exclude or treat people differently because of race, color, national origin, age, disability or sex.
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