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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
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
For all records request: Transfer of Records, Records to
another Physician, Insurance purposes, etc...;
||Fill out the release of information form
or mail to:
PO Box 43