This form is a sample letter in Word format covering the subject matter of the title of the form.
Authorization Letter With Signature In Hennepin
Category:
State:
Multi-State
County:
Hennepin
Control #:
US-0023LTR
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
Hennepin Healthcare System, Inc. operates Hennepin County Medical Center in downtown Minneapolis and primary care clinics in Minneapolis on East Lake Street and in the Whittier Neighborhood and in the suburban communities of Brooklyn Center, Brooklyn Park, Golden Valley, Richfield, and St. Anthony.
Begin by specifying your name, the entity authorized to disclose information, and the individuals or entities you authorize to receive it. Indicate the specific information and purpose for which it will be disclosed, add an expiration date or event, and sign and date the form to confirm your consent.
In order to get access to your records, you'll need to complete the consent form to release your medical information. Once the form is completed and sent to your medical provider, they must send you a copy of your complete information promptly.
Download the Authorization to Release Health Information form and return it to the HIM Department at Hennepin Healthcare. Forms may be received via fax, by mail, or in person. You may request your records on paper or in an electronic format. Fax your release form at 612-873-1516.
Online Access to Your Health Information Check with your health care providers or doctors to see if they offer online access to your medical records. Terms sometimes used to describe electronic access to these data include “personal health record,” or “PHR,” or “patient portal.”
Records retention. The provider shall retain a client's records for a minimum of seven years after the date of the provider's last professional service to the client, except as otherwise provided by law.
