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Attorneys: HCMC employees looked at George Floyd's private 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the patient's information, including their full legal name, date of birth, maiden name or alias, social security number, and phone number.
- In the 'Health Information Released FROM' section, select either Hennepin Healthcare System or specify another organization by providing its name and address.
- Fill out the 'Health Information Released TO' section with the recipient's details, ensuring you include a complete address and fax number if applicable.
- Indicate the health information to be released by specifying dates of service and types of visits. Be sure to initial any sensitive information you do not wish to release.
- Choose the form or format for release—hard copies, electronic formats, verbal exchange, or review of records—and indicate your preferred delivery method.
- Complete the authorization section by signing and dating the form. Ensure that any legal representatives provide necessary documentation.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2020 | 4.8 Satisfied (226 Votes) |
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