Release Medical Records

FAX: 507-646-1192

Authorizations to Release Medical Forms

Medical Records - 507-646-1182.

Please fill out the appropriate form and fax to  507-646-1192.


Authorization for Disclosure Form – Records sent to NH&C Clinic 

Authorization for Release of Information Form - Records to be sent to another facility 

Authorization for Minor Consent Form - Permission for family or friend to bring minor child for treatment and discuss 




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FAX: 507-646-1192