Authorization for the Release of and/or Request for Patient Access to Health Information
Patient medical records are maintained for all who receive treatment at Lakeview Hospital. All patient encounter information is maintained in the Health Information Services (HIS) department. This physical record is the property of Lakeview Hospital. However, the patient and/or their appointed representative may authorize disclosure of their protected health information with a properly signed authorization. In accordance with Minnesota law, there may be a fee associated with a release request.
The Health Information Services department is open from 8:00 am to 5:00 pm, Monday through Friday. They may be reached at (651) 430-4596.
To authorize and request release of your protected health information, please complete the Authorization for the Release form and mail it to:
Lakeview Hospital
Attn: HIS
927 Churchill St. W.
Stillwater, MN 55082
You may also FAX the completed and signed form to:
(651) 430-4660
The business office record includes the itemization of charges and any billing, payor insurance information on file. If you wish to receive a copy of this record as well, please check the Itemization of Charges box on the form.
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