MEDICAL RECORDS RELEASE


To release medical records, we would like to have a completed authorization form. You must be 18 years of age or the parent or legal guardian of a minor. Follow these instructions to ensure smooth processing of your request:

· Download and print Release of Information Authorization.
(You must be 18 years of age or the parent or legal guardian of a minor)

· Fill out the form as completely as possible.

· Include the name and address the records should be released to.

· Be as specific about the information you'd like released.

· Mail the authorization form to the appropriate location.

Cavalier County Memorial Hospital
9012nd St.
Langdon ND 58249
Phone: 701-256-6240
701-256-6198
Fax: 701-256-6129