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  • Allina Release Of Information

Get Allina Release Of Information

ALLINA HEALTH / TWIN CITIES SPINE CENTER AUTHORIZATION TO RELEASE AND DISCLOSE PATIENT INFORMATION PATIENT INFORMATION NAME: DATE OF BIRTH: Address: Day Phone: State City: Clinic/Hospital/Health Care.

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Include signature, printed name, date, and records desired. Release a copy only, not the original. The physician may prepare a summary of the medical record, if acceptable to the patient.

The ROI form gives the healthcare organization — like a hospital — the authority to release a specific portion of your medical record. When the healthcare organization receives the ROI request, the ROI department immediately records it. They also check whether or not the authorization is valid.

Call Care Management Intake at 612-262-8100 to file a complaint or report a concern. Call the Allina Health Integrity Line at 1-800-472-9301.

A release of information is a document that gives a consumer the opportunity to decide what material they want released from their medical file, who they want it delivered to, how long the data can be issued, and under what statutes and guidelines it is released.

Hospitals and health systems are responsible for protecting the privacy and confidentiality of their patients and patient information. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations established national privacy standards for health care information.

Release of information is the process of providing access to protected health information (PHI) to an individual or entity authorized to receive it. Even with electronic health records, the process is complicated and governed by both federal and state regulations.

Completed Forms can be sent via: Email: MedicalRecords@allina.com Mail To: Allina Health, Attn: Health Information/ROI PO Box 43, Minneapolis, MN 55440-0043 Allina Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, gender ...

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232