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 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.
- Authorization for Release of Protected Health Information
- Patient Access to Their Protected Health Information
You may fax the completed form to: Health Information Management at 218-643-0869
-OR-
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