To obtain a copy of your medical record or have a copy forwarded to another organization or person, please complete the Authorization for Release of Information form. A copy fee may be charged. Please call 218-643-0289 for current copy fees.
You may download either PDF version of the form below. You will need to print the form, complete all appropriate areas, sign and date.
You may fax the completed form to: Health Information Management at 218-643-0866
You may mail the form to:
Health Information Management
St. Francis Healthcare Campus
2400 St. Francis Drive
Breckenridge, MN 56520
Please contact the Health Information Management Department with any questions or comments you may have regarding your health information or medical record.Patient Access to Their Protected Health InformationPatient Access to Their Protected Health Information