Release of Information
Authorization for Use or Disclosure of Protected Health Information Access to Protected Health Information Form
In order to process your request for medical records, please complete all the fields on the ‘Authorization for Release of Information’ form. Please pay careful attention to complete all areas of the form. If not completed, we may need to return your request for more information.
- Patient Access Request to Their Protected Health Information
- Authorization For Use or Disclosure of/Access to Protected Health Information
Please call 701-742-3610 with questions about release of medical records or if you need assistance completing the authorization form.
Once you have completed and signed the form(s), utilize one of these options:
- Fax it to:
- Mail it to:
CHI Oakes Hospital
Hospital HIM Department
1200 N 7th St.
Oakes, ND 58474
Return it to the facility Registration Office and the authorization will be hand delivered to the HIM Department and your request processed.
CHI Oakes Hospital HIM Department