Patient authorization release information 2025

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, and contact details. Ensure all information is printed legibly.
3. In the 'Who has the information you want released?' section, provide details about the healthcare provider or facility holding your records. If it's a HealthPartners facility, refer to the address list provided.
4. Specify where you want the information sent in the 'Where do you want the information sent?' section. Include as much demographic information as possible for accurate delivery.
5. Indicate what specific information you need by checking appropriate boxes under 'Information to be sent.' You can specify categories like clinic visits or individual documents based on your needs.
6. If applicable, check any special permissions required for sensitive records in the 'Special Permissions' section.
7. Select a purpose for releasing your health information from the options provided. This helps prioritize processing your request.
8. Choose your preferred release method—whether by mail, fax, or electronic means—and enter any necessary dates related to appointments or pickups.
9. 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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