Patient Forms
| Authorization for
Release of Information
1. Download Form – Authorization of Release of Information 2. Complete the Authorization for Release of Information form in its entirety. Be sure you sign and date the form. If you need any assistance, feel free to contact Health Information Management at (701) 530-8935. 3. Send completed form by e-mail, fax or by mail to Health Information Management. If you are emailing the form, you must scan the completed document and attach it to your email. The form is not interactive. E-mail to: Fax to: (701) 530-8984 US Mail: Health Information Management St. Alexius Medical Center PO Box 5510 Bismarck, ND 58506-5510
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