Release of Information

In order for the Alexandria Clinic to process your request for the release of your medical records, you must complete a form called the Authorization to Release Protected Health Information. We cannot process an incomplete form, so it is important that you complete each section.  Please remember to sign and date the form and mail it to

Alexandria Clinic, A Service of Douglas County Hospital 
Attn:  Medical Records 610 30th Avenue West
Alexandria, MN  56308

Verbal Release of Information Form

Release of Information Form

Authorization Revocation Form 

If you have general questions on the authorization process, please call (320) 763-2501 or fax (320) 763-7883. Please do not add personal information through fax (birthdate, dates of service, diagnosis, or procedures).

Frequently asked questions

Is there a charge for a copy of my medical record?

We provide current medical information (up to one year) free of charge. If you need your entire medical record, there is a charge. Call (320)762-6086 for an estimate of charges.

How long will it take to get a copy of my medical record?

We usually process requests within five business days.

Can I obtain the medical record of a deceased patient?

The personal representative or next-of-kin may authorize the release of a deceased patient’s medical record, with documentation of a POA or a death certificate.

How can I obtain copies of my children’s medical records?

Under most circumstances, a parent can authorize release and get copies of medical records for a child who is under age 18. The parent must complete and submit an Authorization to Release Protected Health Information.

Can I obtain copies of my spouse’s medical record?

You can only obtain a copy with the patient’s signed authorization.

How do I obtain a copy of my birth certificate?

We don’t have copies of birth certificates for babies born at DCH.  In Minnesota, you call the Minnesota Department of Health at (651) 201-5970 or go to www.health.state.mn.us. You can also contact your county’s Vital Records Division, which is usually in the County Recorder’s Office.