Alumni Relations
Authorization to release protected health and financial information
MEDICAL RECORDS
To authorize release of your protected health information, please download and fill out an authorization form and mail to the address below. Indicate who (e.g. yourself, attorney, probation officer, treatment center, etc.) your health information should be mailed to in the appropriate space on the form.
Click here to: Download an Authorization Form
Hazelden Foundation
Health Information Department BC 22
P.O. Box 11
Center City, MN 55012-0011
Phone: 651-213-4121
Fax: 651-213-4496
PATIENT ACCOUNTS
To authorize release of your protected health information to Insurance, Managed Care, Review Agencies or others involved with your funding arrangements to bill, file claims, support the claims or other communication relating to funding for your treatment at Hazelden, please download and fill out the financial authorization form and mail to the address below.
Click here to: Download a Financial Authorization Form
Hazelden Foundation
Patient Accounts RW 18
P.O. Box 11
Center City, MN 55012-0011
651-213-4345
