Medical Records and Release of Information

Requesting a Copy of Your Medical Records

Students may request physical or electronic copies of their medical records for any services rendered at Student Health Service. In order to obtain a copy of these records, the student must first fill out and sign the Authorization to Release Medical Information form. Once this form has been submitted, please allow 5-10 business days to process this request. If you have any questions on how to fill out this form, please contact (701) 231-7331. The completed form can be sent to us any of the following ways:

Electronic records can be sent to the student via secure message through the Student Health Portal or by email. Please note we cannot guarantee confidentiality or security if students want their informatoin sent via email. 

We are unable to re-release any records that have been sent to us from outside facilities. If you need to obtain copies of these records, please contact the facility the services were received at directly. 

Student Health Portal

Currently enrolled students have access to the Student Health Portal, which may be an option for obtaining copies of some health records, including immunizations. When printing records through the Portal, a signed authorization form is NOT needed. 

Former students who are not currently enrolled may no longer have access to the Student Health Portal. 

Instructions to Complete the Release Form

Please follow these instructions for completing the Authorization to Release Medical Information  form. If you have any questions, please contact Student Health Service (SHS) at (701) 231-7331. 

The individual requesting information will fill in their information for the sections at the top of the form that asks for name, date of birth, student ID and telephone number.

1. Please select the check box that is applicable for the request and fill in that individual or facility's information:

  • Release to means that the student is allowing us to release information to them self, another individual, or a facility (such as a hospital/clinic)
  • Receive from means that the student is allowing SHS to receive records from another individual or facility
  • Exchange with means that the student is allowing an exchange of information between SHS and the person and/or facility that is named under this section

2. Information to be released: Be specific what type of information is being requested. If you want all information to be released, please select "All information".

3. Records from the time: This section dictates the time range of the information that can be released. This document can be future dated for up to one year from the date it was signed. 

4. Purpose of Disclosure: Select the appropriate reason for your request.

Items 5-9 provide information about how this form is used, so please read through these carefully. 

In order to be complete, the form must be signed and dated.

Special Authorization: There are certain items that need special authorization before they can be released. If any of these topics apply to the information you are requesting, please make sure to select the item(s) and sign and date the form again. 

Privacy Information

For students 18 years of age or older, Student Health Service is unable to disclose any information regarding a students' care to family, friends, roommates, instructors, or other individuals unless written consent has been provided by the student.

The form needed to allow verbal disclosure of medical records is called Authorization for Disclosure of Protected Health Information. 

The form needed to request physical copies of medical records is called Authorization to Release Medical Information. 

Feel free to read through our Notice of Privacy Practices which states how and when your medical information can be used or disclosed. 

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