Edina Family Physicians

24 Hour Phone: 952 925 2200


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Records Requests
  Click on the blue document link to open and print.

* RELEASE OF INFORMATION: In order to obtain records from Edina Family Physicians or an Allina
facility, you need to fill out a Release of Information form or Authorization to Release and
Disclose Patient Information form. 

Please fill out this document in blue or black ink pen, write legibly and fill in each required field. 
Each section is required to be filled out completely in order for the "Authorization" to be accepted and fulfilled.

If you have any questions filling out this form - see the second page for instructions. 
You can also call the Allina Commons HIM team at 612-262-2300 and they can answer any questions you may have.

* For all records request: Transfer of Records, Records to another Physician, Insurance purposes, etc...
  Fill out the release of information form
Fax to 612-262-2323
or mail to:
    Allina Health
    PO Box 43
    Minneapolis, MN 55440-0043

To request records from MyAcount
  • Login to your MyAccount
  • Click on Health Record (MyChart)
  • Click on the Request Health Record account link on the right hand side of the page
  • All questions call 612-262-2300

EFP   |  Allina  

Medical Records Release Form
Fax All requests to 612-262-2323

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