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Records Requests
 
  Click on the blue document link to open and print.

* RELEASE OF INFORMATION: In order to obtain records from Edina Family Physicians or an Allina
facility, you need to fill out a Release of Information form or Authorization to Release and
Disclose Patient Information form. 

Please fill out this document in blue or black ink pen, write legibly and fill in each required field. 
Each section is required to be filled out completely in order for the "Authorization" to be accepted and fulfilled.

If you have any questions filling out this form - see the second page for instructions. 
You can also call the Allina Commons HIM team at 612-262-2300 and they can answer any questions you may have.
 

* If you are requesting Mammogram films:
  Fill Out the release of information form
Fax to 952-925-0335
or mail to:
     Edina Family Physicians
     5301 Vernon Ave S.
     Edina, MN 55436
   
* If you are requesting other imaging - CT, X-ray, Ultrasound:
  Fill out the release of information form
Fax to 952-848-0646
or mail to:
     Edina Family Physicians
     5203 Vernon Ave S.
     Edina, MN 55436
   
* For all other records request: Transfer of Records, Records to another Physician, Insurance purposes, etc...;
  Fill out the release of information form
Fax to 612-262-2323
or mail to:
    Allina Health
    PO Box 43
    Minneapolis, MN 55440-0043

      
  Edina Family Physicians
5301 Vernon Ave. S. Edina, MN 55436
Edina Family Physicians / Imaging Center
5203 Vernon Ave. S. Edina, MN 55436
Edina Family Physicians
Medical Record Release Forms
 

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