Your medical record contains information regarding your personal health. This includes immunizations, allergies, hospitalizations, medications, diagnoses, treatments and health history. At Altru, we take patient confidentiality seriously, and we will always keep your records private and safe.
Release of Information Authorization Form
To obtain a copy of your medical records, download and print a copy of our Release of Information Authorization form. Fill the form out as completely as possible and mail it to the appropriate location.
For the Grand Forks locations, mail to:
Release of Information
Altru Health System
1200 S Columbia Rd
P.O. Box 6002
Grand Forks, ND 58206-6002
Fax: 701.780.1047
For other locations, mail the form to the clinic where you received services. Search our locations to find the correct address.https://www.altru.org/our-locations/
If you do not have access to a printer, you can pick up a copy of the form at any of our locations.
You must be 18 years old or a parent or legal guardian to request medical records.
You can also sign up for MyChart to view your records, access your test results and pay your bill online.
Additional Forms
Patient Amendment Request Form
Authorization to Disclose Clinical/Financial Information
Frequently Asked Questions About Medical Records
Can I review or receive copies of my own medical record?
Yes, under normal circumstances, you have the right to access your own medical records. If you wish to view your medical records, you need to make an appointment. To view or receive copies of your medical records, you will need to provide written authorization.
How long does Altru keep my medical records?
Medical records for adult patients are kept until at least the tenth anniversary of the date on which the patient was last treated at any Altru Health System facility.
Who is authorized to sign for release of medical records?
The authorization must be signed by the patient, a parent if the patient is a minor, or the patient's legally empowered representative.
Who is authorized to sign for release of medical records if the patient is deceased?
For a deceased patient, the authorization must be signed by the appointed personal representative. A responsible next of kin, including a surviving spouse, an adult child, or a parent, may also authorize release of records.
Is there a charge to request copies of medical records?
There is a $20 minimum charge for personal copies of medical records as well as copies sent to law firms and insurance companies. The total cost depends on the number of pages requested and is charged according to North Dakota and Minnesota statutes. Records may be sent to another healthcare provider at no charge.
Is there a charge to request copies of X-ray images?
There is a charge of $15 per CD for copies of X-ray images, unless the images are sent directly to another healthcare provider.
When you send records to another facility, do you send copies or the original? Will there still be information at Altru Health System if I return as a patient?
The medical record is a legal document and is the property of Altru Health System. Therefore, the original medical record stays at Altru Health System and copies are sent to the other facility.
Can my doctor, who is outside of Altru Health System, just request my records?
Yes, if you are under treatment from that doctor.
Who can pick up medical records?
If someone other than the patient will be picking up copies of medical records, please let us know in advance. The person picking up the medical records must bring written authorization from the patient. Personal identification is required for all pickups.
