Release of information
Request Records Electronically
CHI St. Francis now offers an online patient record request tool that verifies your identity by asking for a photo of your driver's license, which can be taken via webcam or smartphone. Please note: Chrome, Safari and Firefox are the recommended browsers for this application. Below is the link that will launch the online tool to request medical records electronically:
Request Records by Completion of Authorization Form or Patient Access Request Form
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 218-616-3039 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.
- Authorization for Release of Protected Health Information
- Patient Access to Their Protected Health Information
You may fax the completed form to the number below or call for questions.
Contact information for medical records:
- Phone: (610) 601-8922
- Email: CSCENTRAL_PNW@mrocorp.com
- Fax: 1-800-707-4605
-OR-
You may mail the form to:
CHI St. Francis Health
Health Information Management
2400 St. Francis Drive
Breckenridge, MN 56520
Cost for Patients to Request Medical Records
- Electronically maintained records delivered in electronic format $6.50
- Paper Record delivery fax/mail/email/USB $6.50
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