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  • Health Records Release Form

  • According to MN Statute 144.292 Subd.2 Affinity Care MN has 30 calendar days to process a written records release request
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  • Date Range of Record Request

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  •  I acknowledge that by electing to receive health information via email in a non-secure manner the information will not be encrypted and that it could be intercepted and viewed by a third party. Affinity Care is not responsible for unauthorized access to your health information while it is being transmitted to the email address you designated above.

    • A request for substance use disorder and HIV-specific treatment records requires a separate authorization.
    • A program participant will not be charged a fee for the first copy of the patient record but may be charged for additional copies of the same record.
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  • Affinity Care MN complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, gender identity, or sex.

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