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Your medical record contains information regarding your personal health. This includes immunizations, 过敏, 住院治疗, 药物, 诊断, treatments and health history. 在Altru, we take patient confidentiality seriously, and we will always keep your records private and safe.

Release of Information Authorization Form

To obtain a copy of your medical records, download and print a copy of our Release of Information Authorization form. Fill the form out as completely as possible and mail it to the appropriate location.

For the Grand Forks locations, mail to:

Release of Information
Altru 健康 System
P.O. 6002箱
Grand Forks, ND 58206-6002
传真: 701.780.1047

For other locations, mail the form to the clinic where you received services. 搜索 our locations to find the correct address.

If you do not have access to a printer, you can pick up a copy of the form at any of our locations.

You must be 18 years old 或者父母 or legal guardian to request medical records.

You can also sign up for MyChart to view your records, access your test results and pay your bill online.


病人 Amendment Request Form

Authorization to Disclose Clinical/Financial Information

Frequently Asked Questions About 医疗记录

Yes, under normal circumstances, you have the right to access your own medical records. If you wish to view your medical records, you need to make an appointment. To view or receive copies of your medical records, you will need to provide written authorization.

Medical records for adult patients are kept until at least the tenth anniversary of the date on which the patient was last treated at any Altru 健康 System facility.

The authorization must be signed by the patient, a parent if the patient is a minor, or the patient's legally empowered representative.

For a deceased patient, the authorization must be signed by the appointed personal representative. A responsible next of kin, including a surviving spouse, 一个成年的孩子, 或者父母, may also authorize release of records.

There is a $20 minimum charge for personal copies of medical records as well as copies sent to law firms and insurance companies. The total cost depends on the number of pages requested and is charged according to North Dakota and Minnesota statutes. Records may be sent to another healthcare provider at no charge.

There is a charge of $15 per CD for copies of X-ray images, unless the images are sent directly to another healthcare provider.

The medical record is a legal document and is the property of Altru 健康 System. 因此, the original medical record stays at Altru 健康 System and copies are sent to the other facility.

Yes, if you are under treatment from that doctor.


If someone other than the patient will be picking up copies of medical records, please let us know in advance. The person picking up the medical records must bring written authorization from the patient. Personal identification is required for all pickups.

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