Patient authorizes the physicians, medical attendants, and the hospital to furnish full and complete medical information to the specified attorney at law, or to any representative or investigator from his/her firm. The form also provides that all prior authorization is cancelled.
Medical Authorization Form For Elderly Parents In Hennepin
Category:
State:
Multi-State
County:
Hennepin
Control #:
US-00426
Format:
Word;
Rich Text
Instant download
Description
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FAQ
Get help. Call the Hennepin County Managed Health Care Office at 612-596-8860 for help with enrollment questions, billing questions, or complaints.
Sign in to My UNC Chart or the patient portal where you got care and request a copy of your medical records. Fill out an authorization form for medical records and drop it off at one of our locations in person. Fill out an authorization form for medical records and mail it to one of our locations.
You can call us at 612-873-3180 to inquire if your request has been processed and sent.
In 2018, HCMC became Hennepin Healthcare.
You may request your records on paper or in an electronic format. Fax your release form at 612-873-1516. In-person: For form drop-off, please leave your form in the black box near the office door of the Medical Records Office at Hennepin Healthcare.
Apply for health care assistance Most people can apply online at MNsure or call 1-855-366-7873. People 65+ and people with a disability: Download and complete an application and submit to Hennepin County.
Medicaid. A state and federal program (called Medical Assistance in Minnesota) that provides health insurance that covers a broad array of health services for people, including families and children with low-incomes, older adults and people with disabilities.
To schedule an appointment by phone, call 612-873-6963, Monday through Friday am to pm. To schedule online, current patients can log into MyChart or create an account if you don't have one. If you are a new patient, please use our easy online scheduling portal.