Authorization for the Release of and/or Request for Patient Access to Health Information
According to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations and Minnesota law, patients have the right to access their health information, as defined by Lakeview's policy. Some exceptions per HIPAA and Minnesota law may apply.
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. Your medical record is the property of Lakeview Hospital. 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 (651-430-4596) is open from 8:00 am to 4:30 pm, Monday through Friday. If you are picking up information during the hours of 3:00 pm to 4:30 pm, please stop at the hospital's main floor reception desk and ask them to call the HIS department.
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.
|
