RELEASE OF MEDICAL RECORD PROCEDURES

You may request a copy of your medial records by completing an Authorization for Disclosure of Medical Records form and submitting it to the Minneapolis Clinic of Neurology.

Mailing Address

Minneapolis Clinic of Neurology
Attention: Medical Records
4225 Golden Valley Road
Minneapolis, MN 55422

Medical Records Fax

763-287-2318

Frequently Asked Questions Related to the Release of Medical Records

Who is authorized to sign for the release of my health information?

The following individuals are authorized to sign for release of your health information:

• The patient (not the patient’s spouse)
• Power of attorney, if the patient is unable to sign (power of attorney document must be provided)
• Parent, if the patient is younger than age 18
• Legal guardian (proof of guardianship document must be provided)
• Representative of the estate for deceased patients (a copy of the death certificate and a copy of the representative of estate documents must be provided)

How much does it cost to obtain a copy of my health information?

• Patients receive their first personal copy of their patient visit at no charge. There will be a charge of $1.22 per page, or $10.00 per CD for subsequent requests.
• There is no charge for releasing copies of health information directly to other healthcare providers.
• Copies for parties other than patients and healthcare providers will be charged processing fees, per page and/or CD fees and postage (based on the Department of Labor’s annually adjusted postage fee).

When will I receive a copy of the medical records?

Copies are processed within 7 to 14 days from the date of the request.

Who do I contact if I have questions?

If you have any questions, please contact the Medical Records Department at 763-588-0661 and enter the extension by the first letter of the patient’s last name:

A-H     Ext. 4121
I-M      Ext. 4123
N-Z      Ext. 4122

All MRI films  Ext. 4062