Hcmc release of information 2026

1. Click ‘Get Form’ to open the hcmc release of information in the editor.
2. Begin by filling out the Patient Information section. Enter the patient's full legal name, date of birth, maiden name or alias, phone number, and social security number.
3. In the Health Information Released FROM section, select one option: Hennepin County Medical Center or Other. If you choose 'Other', provide the organization’s name and address.
4. For Health Information Released TO, input the name and complete address of the person or organization receiving the information, including fax number if applicable.
5. Specify the Health Information to be Released by indicating a date of service and type of visit. Check relevant report types or write 'Any and All' for full records.
6. Review sensitive information options. Initial any lines for alcohol/drug use, mental health records, or HIV/AIDS records that you do not wish to release.
7. Select Type of Release by checking appropriate boxes for hard copies, verbal exchange, CD, or review of record.
8. Indicate Purpose of Release and Delivery Method by checking relevant boxes for mail, fax, or pick up by patient/designee.
9. Finally, sign and date the authorization at the bottom. Ensure all fields are completed for a valid submission.

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