Edina Family Physicians  

24 Hour Phone: 952 925 2200

 

Home Resources | Forms  Our Providers MyAccount  

Our Doctors

 

Locations
Administration
Services
Insurance
Patient Education
Awards | Recognition
Videos
Links
Resources | Forms
News | Publications
Health Management
Employment
Patient Privacy
Pay Your Bill Online or By Call 612 262 9000

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.
 

   
* For all 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

      
EFP   |  Allina  

Medical Records Release Form
Fax All requests to 612-262-2323

Copyright 2018 | EDINA FAMILY PHYSICIANS Affiliated with AllinaHealth

(Our Website is ssl compliant and has "alt" tag descriptors on most images and links.)