If you've been receiving your health care outside of Mayo Clinic Health System, you'll need to complete an authorization form to allow that facility to share your medical record with us. Transferring your medical records to us ensures your Mayo Clinic provider knows about previous health conditions and any treatments.
The same form is also used to give us permission to share your medical records with another health care provider, system or individual — such as a family member who will assist with your care.
To begin, choose a form based on the location you'll receive your care:
Fairmont (includes Armstrong, Blue Earth,Sherburn and Truman)
Mankato (includes Eastridge, Northridge, Specialty Clinic, Lake Crystal, Le Sueur and St. Peter)
Print, complete, sign and return it to Mayo Clinic Health System in one of the following ways:
Fax it to "Release of Information". Refer to the fax number listed in step 2 on the form.
Bring it with you to your next appointment.
Mail it to the address listed in step 2 on the form.
If you need help completing the form, refer to the instructions on each form or call 507-594-2621 and select option one.
Family medical history can play a large role in your health. To help you and your provider have a full understanding of your family history, print and complete the Patient/Family History Form. Bring the completed form to your first appointment.
Privacy and security
Part of our commitment to caring for you is making sure your health information is secure. We make it a priority to treat your medical information in confidence while adhering to federal regulations regarding the use and protection of medical and health information.
At your first appointment, you'll receive a copy of the Mayo Clinic Notice of Privacy Practices. You'll be asked to sign a form acknowledging the fact you received it. The acknowledgement form is required per federal regulations. Signing the form only means you've received the notice, and in no way affects the care you'll receive at Mayo Clinic Health System.
If you have any questions about the privacy notice or acknowledgement form, contact the Privacy Officer at 507-594-6395.
Call 507-594-2621 if you need assistance or have questions about your medical records.