Authorization to Release Medical Records Forms
Medical Records - 507-646-1182.
There are several different options for medical records, please choose the one you want and fill out the appropriate form and fax it in.
Authorization to Release Health Information - To send medical records to another health care facility from Northfield Hospital + Clinics, please fill out the Authorization to Release Health Information Form and fax it to our Release of Information Vendor, Vital Records Control, at 312-836-7919. Any questions, call 507-216-0100 or email neintake@vrcnetwork.com
Authorization for Disclosure of Health Information Form - To have your medical records sent to Northfield Hospital + Clinics from another health care facility, please fill out the Authorization for Disclosure of Health Information Form and fax it to 507-646-1192. Any questions, call 507-646-1182.
Authorization for Minor Consent - To provide permission for family or a friend to bring your minor child for treatment and to discuss with your child's health care team, please fill out the Authorization for Minor Consent Form and fax it to 507-646-1192. Any questions, call 507-646-1182.
FAX: 507-646-1192