Release of information

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 701-456-4268 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 218-643-0869


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

Birth certificate request

To request a certified copy of a birth certificate, please contact:

Minnesota Department of Health
Attention: Office of the State Registrar/ Birth Certificates
P.O. Box 64882
St. Paul, Minnesota 55164-0882
Phone: 651-201-5970