Medical Record Request

Who can sign up to get health information for a patient:

• The patient (Not the spouse)
• Power of Attorney if the patient is not able to sign (Legal document must be provided)
• Parent (If the patient is younger than age 18)
• Parent and minor if the patient is 12 to 17 years of age and is getting psychiatric, alcohol, or drug treatment services
• Legal guardian (Proof of guardianship document must be provided)
• Representative of the estate of a patient who expired. A copy of the death certificate and a copy of the representative of the estate must be provided
• Referring Provider

Request Online

Request medical records with our new online tool. Your records are delivered right to you – no need to go and pick them up. Choose from Electronic or Mail delivery. Note: please have your photo ID ready.

Providers: Click here to request a patient’s records

Patients: Click here to request your records

1. Complete Online Request
2. You’ll be guided through every step of the process
3. Review, sign, & submit request
4. And you are done

Request in Person

Or, please download and complete the Authorization for Release of Confidential Information and return to our office.
– Write legibly and sign the release form
– Make sure you fill out the dates you are wanting, where/how you would like it sent, and a good contact number (phone number)
– Include a copy of your picture I.D.

• You may bring your Authorization form in person to the Health Information Management/Release of Information office at Minden Medical Center. Our Office hours are Monday – Friday 8:00am to 4:30pm and our phone number is (318) 371-3216.
• You may mail your Authorization form to:
  Minden Medical Center
  Health Information Management/ROI
  #1 Medical Plaza
  Minden, LA 71055
• You may Fax your Authorization form to: (318) 371-5684
• You may Email your Authorization form to: [email protected]