Medical Record Request

INSTRUCTIONS FOR RECEIVING COPIES OF YOUR MEDICAL RECORDS

There are several ways to contact MMC Health Information Management for release of information.

Please 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

Phone: (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]