Rel of Information

Please completely fill out the Authorization for Use or Disclose of Protected Health Information.  Be sure to include both the name and address of who you would like your records released to.  Be as  specific as possible about the information that you’d like released (example:  specific dates of service, specific treatment, etc)

There may be a charge for copies of your medical records.  Should there be a charge we will notify you before copies are made.  Upon payment for the copies your request will be processed.

Please mail or fax your request to:

Release of Information

Carrington Health Center

PO Box 461

Carrington ND 58421

Fax:  701-652-3030

Authorization for Release of Information