Requesting Your Medical Records

We take client confidentiality seriously and therefore, protect your medical record. Your medical record contains personal health information that could include medications, diagnoses, treatments, etc.

If you are requesting medical records for yourself or your dependent, you can submit your request:

• Via our online, HIPAA-secure request form
• During clinical instruction
• Fax to 218-955-7141 (HIPAA-secure)
• In-person or by mail: NWMHC
                                       Attn: Medical Records
                                       P.O. Box 603
                                       Crookston, MN 56716

Forms

•  Authorization For Use and Disclosure of Protected Health Information [Download PDF]
This document serves as both a Release of Information and a Medical Records request.

•  Release of Information [Download PDF]

603 Bruce Street, Crookston, MN 56716
Phone (Non-Crisis): 218.281.3940 | Toll-free: 1.800.418.7326

© Northwestern Mental Health Center 2019 | Notice of Privacy Practices