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Minnesota State University, Mankato

Minnesota State University, Mankato
Student Health Services

Medical Records Release

Page address: http://www.mnsu.edu/shs/medicalrecordsreleaseform.html

Authorization for Disclosure of Health Information

If you wish to have your medical records transfered from Student Health Services (SHS) Medical Clinic to another clinic, for continued care, personal use, or for another reason you need to click on the link below and fill out the form completely

Return the completed form to SHS Medical Clinic 21 Carkoski Commons, Mankato, MN 56001 or Fax to: 507-389-5787

For further information please call: 507-389-6276

[PDF] Authorization for Disclosure of Health Information (66 KiB)