Request Medical Records

Health Information Services

The Health Information Services (HIS) Department at Community Memorial Hospital recognizes the vital role of health information. HIS is dedicated to ensuring complete and timely documentation of pertinent facts and observations about our patient’s health, including past and present illnesses, tests, treatments and outcomes. We are committed to providing the highest quality of service to our customers by ensuring accurate, reliable, and secure collection, maintenance and appropriate dissemination of patient health information, regardless of its format. We are dedicated to meeting the needs of our customers in a professional, caring and confidential manner. For detailed information on how Community Memorial Hospital uses and safeguards your protected health information, please refer to our Privacy Notice.

Department hours: Monday through Friday, 8:00 a.m to 4:30 p.m. Closed holidays.

Phone: 218-878-7023
Fax: 218-879-3237

For information regarding creating and maintaining a Personal Health Record (PHR) visit the myPHR website.

Frequently Asked Questions:

Q:

Who do my records belong to?

A:

Your medical record is the property of Community Memorial Hospital and is maintained by the hospital for patient care purposes. Although these records are maintained for your benefit, the physical records (paper or electronic) are the property of the hospital.

Q:

Who may request medical records?

A:

You may request copies of your own medical records, the medical records of a minor child, or the medical records of someone for whom you are the legal guardian or hold a Durable Power of Attorney for Healthcare. Proof of legal guardianship or a Durable Power of Attorney for Healthcare must be provided. A Durable Power of Attorney for Healthcare is only effective in the event a patient is unable to act on their own behalf and that has been determined by a physician. A spouse or child of a deceased patient can request the medical records of the deceased if he/she is the executor or administrator of the deceased patient’s estate. Probate Court documents naming the requestor as the executor or administrator must be provided. Where there is no estate or an estate will not be probated, Probate Court documents releasing the estate from probate and naming the requestor as the personal representative must be provided.

Q:

How can I obtain a copy of my medical record?

A:

Simply follow these steps:

  1. Download the Authorization to Release Protected Health Information form.
  2. Complete the authorization form (must be a patient or patient’s guardian/legal representative) and mail, fax, or deliver to:

    Community Memorial Hospital
    ATTN: Health Information Services Dept.
    512 Skyline Boulevard
    Cloquet, MN 55720
    Fax: 218-879-3237

Instructions on completing the Authorization Form:

  1. Print legibly the patient’s complete legal name and maiden name (if applicable), date of birth, address, and phone number.
  2. “This will authorize” — check “Community Memorial Hospital & SHCC
  3. “To Release Records to” — check “Other” and print legibly the name and complete address of the individual and or facility who is to receive the information.
  4. Print the specific date(s) of treatment for which you are requesting.
  5. Check the appropriate boxes to indicate which records you want to be released.
  6. Check appropriate box for the purpose of the disclosure. If Other, be sure to write out the specific purpose.
  7. Read the paragraph “TO THE PATIENT” above the signature line before signing.
  8. Sign and date the authorization. If the patient is under 18 years of age the legal parent or guardian must sign. The authorization is not valid without a signature.

    Once your records are processed, you may pick them up in person at the location above or they can be mailed to your home address. If you pick up your records in person, you will be required to present photo identification. You may send a representative to obtain your records only if they are listed on the authorization form under “To Release Records to” section. It is required for your representative to provide their photo identification as well.

Q:

How soon can I expect the release of my medical record?

A:

Requests are usually processed within 7-10 days.

Q:

I was born/my baby was born at Community Memorial Hospital. How can I obtain a birth certificate?

A:

You will need to request the birth certificate from the local Bureau of Vital Statistics Office. You can reach the local Carlton County office at 218-384-9156.

Q:

My family member passed away at Community Memorial Hospital. How can I obtain a death certificate?

A:

You will need to request the death certificate from the Bureau of Vital Statistics Office. The funeral home works in conjunction with the physician to complete the death certificate. The funeral home then submits the death certificate information to the Bureau of Vital Statistics Office. You can reach the local Carlton County office at 218-384-9156.

Q:

Can I just look at my record?

A:

Yes. To view your medical records:

  1. Contact the Health Information Services Department at 218-878-7023 to schedule an appointment to view your records.
  2. Complete a valid authorization for release of information is required.
  3. Provide photo identification.

If you have any further questions regarding your medical record or release of your health information, please contact us at 218-878-7023.

CMH Urgent Care open Monday thru Friday 5-9pm, Saturday 9am-3pm | Hospital & Emergency Room 218-879-4641
© 2014 Community Memorial Hospital, 512 Skyline Boulevard, Cloquet, Minnesota 55720
Media | Privacy Notice | Corporate Compliance Program | Sitemap