Healthpartners 2026

1. Click ‘Get Form’ to open the Patient Authorization for Release of Protected Health Information in the editor.
2. Complete the Patient Information section by entering your name, previous last name (if applicable), address, date of birth, city, state, ZIP code, and phone number. Ensure all details are printed legibly.
3. In the 'Who has the information you want released?' section, specify the healthcare provider or organization from which you are requesting records. Include as much demographic information as possible.
4. Indicate where you want the information sent in the 'Where do you want the information sent?' section. Provide complete details for accurate delivery.
5. Select the specific information you wish to receive by checking appropriate boxes under 'Information you want sent.' You can choose from categories like clinic visit records or individual reports.
6. Fill out any special permissions required if applicable. This is crucial for sensitive records such as mental health or substance use disorder documents.
7. Specify the purpose for release and select your preferred release method—whether by mail, fax, or electronically via secure email.
8. Finally, sign and date the authorization at the bottom of the form. If someone else is signing on your behalf, indicate their relationship and authority.

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