Release of Health Information

If you would like a copy of your medical records, please download one of the following Authorization for Release of Health Information forms:

CentraCare (PDF)
CentraCare - Monticello (PDF)
Midsota Plastic Surgeons (PDF)

Instructions for completing the Authorization for Release of Health Information form (PDF)

Please be aware that there will no longer be an onsite HIM presence at the CentraCare - Willmar Lakeland Clinic starting Monday, November 14, 2022. If you need to request your records, you can either:

Call Release of Information at (320) 231-5014 and follow the prompts.
Request your records via MyChart.
Obtain an Authorization for Release of Health Information (above) and return the completed form to the corresponding location on page 2.
Visit the HIM department onsite at either:
- CentraCare - Rice Memorial Hospital (attached to the Willmar Lakeland Clinic via the tunnel on the Lower Level) OR;
- CentraCare - Willmar Clinic located at 101 Willmar Ave SW, Willmar, MN 56201