Release of information

We need your written permission to release information from your medical records to insurance companies, attorneys, health care providers that are not covered by your consent for a common medical record among Allina Health EMR affiliates or other parties. Please use the form below to grant your permission and provide instructions to us for delivery of the information.

Authorization to Release Medical Information from GRHS

You can return the form to us by mail or by fax:

Glencoe Regional Health Services
Attention: Health Information Management
1805 Hennepin Ave. N.
Glencoe, MN 55336

Fax: 320-864-7998

Written permission is also needed when transferring your medical records to us. Most health care organizations will send you a release of information form upon request. For your convenience, you may use the one below. Upon completion, mail or fax the form to the organization that has your medical record. They will then send the requested information to us.

Authorization to Transfer Medical Information to GRHS

If you have any questions regarding the use of these forms or the release of your medical information, please call our Health Information Management department at 320-864-7993 or toll free, 1-888-526-4242 x7993.


1805 Hennepin Ave. N., Glencoe, MN 55336
320-864-3121 or 1-888-526-4242 | Map

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