To request the release of your private health records or to authorize care providers to share your personal health information with others, download, fill out, and submit the correct form of the two forms listed below.
To request the release of your private health records, download, fill out*, and submit:
- Authorization for Release of Protected Health Information (PDF format) to request copies of your records
Submit the completed form to the Fairview location where your care was received. At this time, hospital records are not available online or by electronic means. We apologize for any inconvenience. Call the number listed below to answer any questions you may have. Please be aware that our staff is not able to provide requested information to you verbally.
*Fill out the form completely. Incomplete requests cannot be processed.
To authorize care providers to share your personal health information with others, download, complete and submit:
- Authorization to Discuss Protected Health Information - to request that care providers discuss your information with others
Fairview Ridges Hospital
Health Information Management
201 E. Nicollet Blvd.
Burnsville, MN 55337