Release of Information
If you need medical record information for care you received at Park Nicollet sent to a non-Park Nicollet provider, please complete the Park Nicollet Authorization for Release of Information (PDF) Refer to the Authorization Guidelines for help completing this form.
If you need medical record information for care you received at a non-Park Nicollet provider sent to Park Nicollet, please complete the
Non-Park Nicollet Records Authorization for Release of Information (PDF).
If you have questions or need assistance, refer to the Information Sheet or call Health Information Management at 952-993-7600. If you have questions regarding radiology images, call 952-993-5427.
Permission to Discuss Protected Health Information
At Park Nicollet, we understand the importance of privacy when it comes to your health information – that's why we don't discuss your medical care with anyone that you haven't specifically authorized. If you'd like certain friend, family members or others to be involved in your care, please complete the Permission to Verbally Discuss Protected Health Information (PDF). This will let us know who you would like us to talk to regarding appointment information, lab and test results, treatment information and other medical information that you authorize.
To request a certified copy of a birth certificate, visit the Hennepin County Service website.