Release of information form mn 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section 1, which includes your personal information such as first name, last name, date of birth, and contact details. Ensure accuracy for effective communication.
3. In Section 3, specify the organization or healthcare professional from whom you are requesting health information. This is crucial for directing your request appropriately.
4. Proceed to Section 4 to indicate where the health information should be sent. Fill in the organization’s name and address accurately to avoid any delays.
5. In Section 5, select the specific health information you wish to release. Be clear about what categories apply to ensure only necessary data is shared.
6. Complete Section 7 by stating the reason for releasing this information. This helps clarify your intent and ensures compliance with privacy regulations.
7. Finally, sign and date the form in Section 9. If applicable, include a legally authorized representative's signature along with their relationship to you.

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