Copyright 2012 The Children’s Heart Clinic. All Rights Reserved.
Authorization to Release Medical Records
Attached you will find 2 Release of Information Forms. Please select and print the appropriate form that pertains to your needs. Please note, if your child is 18 years of age or older and you are not assigned legal guardianship of your child, the patient will need to complete and sign this form. Turn around time for requests are approximately 72 hours.
You can mail or fax the form back to us at 612-813-8806.
If you have any questions, feel free to contact us directly in Medical Records at 612-813-8807
CHC's Authorization for Release of Information form.