To Download your form of choice, please CLICK on the title below.
Advanced Directives
Authorization of Release of Information
1. Download Form - Authorization of Release of Information
2. Complete the Authorization for Release of Information form in its entirety. Be sure you sign and date the form. If you need any assistance, feel free to contact Health Information Management at (701) 530-8935.
3. Send completed form by e-mail, fax or by mail to Health Information Management. If you are emailing the form, you must scan the completed document and attach it to your email. The form is not interactive.
E-mail to:
smiller@primecare.org
Fax to:
(701) 530-8984
US Mail:
Health Information Management
St. Alexius Medical Center
PO Box 5510
Bismarck, ND 58506-5510
|
