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.

Complete the Authorization for Release of Confidential Information online.

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]