FormsPage address: http://www.mnsu.edu/shs/forms.html
Medical Records Release Forms
This form is used to transfer medical records to or from another clinic or invidual:
- Release of Information Form for General Requests
Special information is requested on these forms to ensure we get the proper records to contrinue your medical care. These forms are for records to be sent to Student Health Services from another facility:
- Release of Information Form for ADD / ADHD Records
- Release of Information Form for Depo Provera Records
Please complete this form prior to coming to your first appointment at Student Health Services.
This form is required if you graduated high school from outside the state of Minnesota or before 1997. You should have received information and a link to this form in your admitted student letter. You may submit the form electronically or send to Student Health Services, 21 Carkoski Commons, Mankato, MN 56001; fax (507) 389-5787; email firstname.lastname@example.org. This information is required before you can register for the following semester at Minnesota State Mankato.