Release of Medical Record Procedures PDF Print E-mail

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 ask for the extension by the first letter of the patient’s last name:

A-H     Ext. 4123
I-O      Ext. 4121
P-Z      Ext. 4122

All MRI films  Ext. 4062

 
Clinic Locations

GOLDEN VALLEY / MAIN OFFICE
4225 Golden Valley Road, Golden Valley, MN 55422
(763) 588-0661

BURNSVILLE
Oak Ridge East Professional Building
675 E. Nicollet Boulevard, Suite 100, Burnsville, MN 55337
(952) 435-8516 (Neurology services)
(952) 898-5000 (Rehab services)

COON RAPIDS
3833 Coon Rapids Blvd., Suite 100, Coon Rapids, MN 55433
(763) 427-8320

EDINA
Southdale Place
3400 West 66th St, Suite 150, Edina, MN 55435
(952) 920-7200 (Neurology services)
(952) 920-8088 (Rehab services)

MAPLE GROVE
North Memorial Medical Office
9825 Hospital Drive, Suite 103, Maple Grove, MN 55369
(763) 302-4114

OUTREACH LOCATIONS
Twin Cities Metro, Greater Minnesota & Western Wisconsin