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href="/web/20101204040050/http://www.fairview.org/index.htm">Home</a></div> <h2><a href="/web/20101204040050/http://www.fairview.org/HIMS/index.htm">Medical Records</a></h2> <div class="sidebarNav sidebarNavLinks"> <ul> </ul> </div> </div> <div class="clear"></div>  <div class="txtBox" id="leftAddress"></div> </div> <div id="sub-right">    <div id="content" style="MIN-HEIGHT: 500px; WIDTH: 618px"> <h3>Medical Records</h3> <p><span class="subHead1">Authorization to release protected health information</span><br/><br/><span class="fvMainBody"> <p><font class="fvMainBody"><img alt="Stock_TeenswithFriends02_LrgVert_FAN2012812" align="right" src="/web/20101204040050im_/http://www.fairview.org/fv/groups/internet/documents/web_assets/stock_teen_2010091708014827.jpg"/>To request the release of your private health records, please download and fill out one of the authorization forms below. Then, call the site where you received treatment to ask how you should submit the form. For contact information, see the list below.</font></p><p></p><p><font class="fvSubHead">Authorization Forms</font></p><ul><li><a href="https://web.archive.org/web/20101204040050/http://www.fvfiles.com/521125.pdf"><font color="#0000ff">Authorization for Release of Protected Health Information</font></a> (PDF format) - to request copies of your records</li><li><a href="https://web.archive.org/web/20101204040050/http://www.fvfiles.com/521129.pdf"><font color="#0000ff">Authorization to Discuss Protected Health Information</font></a> (PDF format) - to request that care providers discuss your information with others</li></ul><p align="left"><font class="fvMainBody">You may call the phone numbers below for help submitting your form. Please note: Staff at these numbers will not share your information verbally.<br/><br/></font></p><p align="left"><span class="subHead1"><font class="fvSubHead">Contact List</font></span></p><p><font class="fvMainBody"><strong>Fairview Clinics</strong> <br/>Call the site (<font color="#0000ff"><a target="" href="/web/20101204040050/http://www.fairview.org/Clinics/index.htm">see clinic list</a></font>)</font></p><p dir="ltr"><strong>Fairview Lakes Medical Center</strong> <br/>Health Information Management<br/>5200 Fairview Blvd., Wyoming, MN 55092<br/>       Phone: 651-982-7870; Fax: 651-982-7122</p><p dir="ltr"><strong>Fairview Northland Medical Center</strong> <br/>Health Information Management<br/>911 Northland Dr., Princeton, MN 55371<br/>    Phone: 763-389-6522; Fax: 763-389-6545</p><p dir="ltr"><strong>Fairview Red Wing Medical Center</strong> <br/>Health Information Management<br/>701 Fairview Blvd., Red Wing, MN 55066<br/>       Phone: 651-267-5550; Fax: 651-267-5939</p><p dir="ltr"><strong>Fairview Ridges Hospital</strong> <br/>Health Information Management<br/>201 East Nicollet Blvd., Burnsville, MN 55337<br/>    Phone: 952-892-2000; Fax: 952-892-2024</p><p dir="ltr"><strong>Fairview Southdale Hospital</strong> <br/>Release of Information, LL25<br/>6401 France Ave. S., Edina, MN 55435-2199<br/>Phone: 952-924-1414; Fax: 952-924-8443</p><p dir="ltr"><strong>University of Minnesota Medical Center, Fairview<br/>University of Minnesota Amplatz Children's Hospital</strong> <br/>Riverside campus<br/>Health Information Management office:  612-273-4370<br/>Release of Information Contact:<br/>    2450 Riverside Ave., Minneapolis, MN 55454<br/>    Phone: 612-273-4359; Fax: 612-273-4069</p><p dir="ltr">University campus<br/>Health Information Management office:  612-626-3535<br/>Release of Information Contact: <br/>     420 Delaware Street SE, MMC 601, Minneapolis, MN 55455<br/>     Phone: 612-626-3238; Fax: 612-273-2345</p></span><br/></p> <p> </p></div></div> <div class="clear"></div></div></div>  <div id="footerContainer" class="footerSwoosh_above png"> <div class="footerNavBox"> <div id="footerNav">  <ul> <li class="start"><strong>Inside Fairview</strong>:</li> <li><a href="https://web.archive.org/web/20101204040050/http://www.fairview.org/Hospitals/index.htm">Hospitals</a></li> <li><a href="https://web.archive.org/web/20101204040050/http://www.fairview.org/Clinics/index.htm">Clinics</a></li> <li><a href="https://web.archive.org/web/20101204040050/http://www.fairview.org/Providers/index.htm">Doctors & Providers</a></li> <li><a href="https://web.archive.org/web/20101204040050/http://www.fairview.org/Services/index.htm">Services</a></li> <li><a href="https://web.archive.org/web/20101204040050/http://www.fairview.org/HealthLibrary/index.htm">Health Library</a></li> <li class="end"><a href="https://web.archive.org/web/20101204040050/http://www.fairview.org/About/index.htm">About Fairview</a></li> </ul> <div class="clear"> </div> </div> <div id="footerSubNav">  <ul><li class="start">© 2010 Fairview Health Services. 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