Medical Records

Authorization to release protected health information

To request the release of your private health records, please download and fill out one of the authorization forms below. Then, call the site where you received treatment to ask how you should submit the form. For contact information, see the list below.

Authorization Forms

You may call the phone numbers below for help submitting your form. If representatives are assisting other callers, please listen carefully for recorded message options.

Please note: Staff at these numbers will not share your information verbally.

Contact List

Fairview Clinics (see clinic list)
Health Information Management
4000 Central Ave.
Columbia Heights, MN 55421
Phone: 952-924-5165
Fax 952-915-8824   

Fairview Lakes Medical Center
Health Information Management
5200 Fairview Blvd., Wyoming, MN 55092
Phone: 651-982-7870; Fax: 651-982-7122

Fairview Northland Medical Center
Health Information Management
911 Northland Dr., Princeton, MN 55371
Phone: 952-924-5165; Fax: 952-915-8824

Fairview Ridges Hospital
Health Information Management
201 East Nicollet Blvd., Burnsville, MN 55337
Phone: 952-924-5165; Fax: 952-915-8824

Fairview Southdale Hospital
Release of Information, LL25
6401 France Ave. S., Edina, MN 55435-2199
Phone: 952-924-5165; Fax: 952-915-8824

University of Minnesota Health Maple Grove Clinics 
Health Information Management
14500 99th Avenue North Maple Grove, MN 55369
Phone: 952-924-5165; Fax 763-898-1009

Fairview Range 
Call the site (See list of clinics)

Fairview Home Infusion
Medical Records Department
711 Kasota Ave SE
Minneapolis, MN 55414

University of Minnesota Medical Center  
University of Minnesota Masonic Children's Hospital
West Bank campus  
Health Information Management office:  612-273-4370
Release of Information Contact:
2450 Riverside Ave., Minneapolis, MN 55454
Phone: 952-924-5165; Fax: 952-915-8824

East Bank campus  
Health Information Management office:  612-626-3535
Release of Information Contact: 
420 Delaware Street SE, MMC 601, Minneapolis, MN 55455
Phone: 952-924-5165; Fax: 952-915-8824 

View the release form for all sites.