The releasor authorizes his/her employer to release employment references including, but limited to, his/her employment history and wages and any information which may be requested relative to his/her employment, employment applications, and other related matters, and to furnish copies of any and all records which the employer may have regarding his/her employment.
Reasons For Release Of Information In Hennepin
Category:
State:
Multi-State
County:
Hennepin
Control #:
US-00458
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
In 2018, HCMC became Hennepin Healthcare.
For same day processing, you must call Hennepin County Vital Records directly at 612-348-8240 before pm (CST).
Hennepin County Public Health works to improve the health of all county residents by addressing social and environmental factors that impact their health and offering programs and services that help them be healthy. Our department is committed to advancing health and racial equity.
Hennepin Healthcare System is the state's largest Medicaid provider system and safety-net trauma hospital in Minnesota, proudly serving the most complex populations from throughout the state.
Call 612-348-3000, Monday through Friday, 8 a.m. to p.m.
You may request your records on paper or in an electronic format. Fax your release form at 612-873-1516. In-person: For form drop-off, please leave your form in the black box near the office door of the Medical Records Office at Hennepin Healthcare.
The primary purpose of a release of information form is to protect the patient's privacy and ensure that their medical information is only shared with their consent. It empowers patients to control who has access to their personal health data and under what circumstances.
You may request your records on paper or in an electronic format. Fax your release form at 612-873-1516. Mail to: HIM Dept. In-person: For form drop-off, please leave your form in the black box near the office door of the Medical Records Office at Hennepin Healthcare. Blue Building 1st floor (B1.114), 900 S.
Hennepin County Public Health is committed to advancing health and racial equity. Mission: Advance health and racial equity through science, and prevention-focused, inclusive, public health policies, practices, and services.
