|
A Release of Information Authorization Form (MS Word or PDF) is used by an individual to consent to the release of his or her medical records/films to a new or different physician, to assist in a job application or when applying for certain insurance. A parent or legal guardian may also fill out an authorization to consent to the release records. An individual acting as an attorney in fact through a power of attorney may also use this form.
To protect the patient's privacy, the law permits disclosure of information only if the patient (or his or her legal representative) consents in writing or if the law otherwise permits it.
Obtaining an Authorization for Release of Information
By phone:
612-775-6200
By fax:
612-775-6222 (Attention: Medical Records)
By mail:
Medical Records
Twin Cities Spine Center
Piper Building, Suite 600
913 East 26th Street
Minneapolis, MN 55404-4515
After downloading the form and completing the information, please use the mailing address or fax to submit the request. Twin Cities Spine Center contracts with a copy service to make every attempt possible to fill medical record/film requests in a timely manner. However, if the requested records/films are in off-site storage, some medical record/film requests may take up to ten business days to process upon receipt.
Download a Medical Information release form in MS Word or PDF format.
Film Requests
It is the policy of the Twin Cities Spine Center to loan films to other facilities if they are needed for ongoing patient care. Copies of films are also available if needed by another facility or for the personal use of the patient. Please contact our office at 612-775-6200 for information and fees involved in the copying of films.
|
