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GICH - Medical Records

Medical Records

Grand Itasca is committed to the privacy and confidentiality of your personal and medical information. You have entrusted us with the responsibility of providing care for you and your family, and we are dedicated to maintaining that trust.

If you have questions about Release of Information, please contact us at 218-999-1517 or by fax at 218-999-1513.

Release of Information

Should you need your medical records for care that you received at Grand Itasca released, please complete this form. Completed forms can be email here.

Verbally Discuss

If you need to give medical staff permission to verbally discuss your medical and/or billing information with others, please use this form.

Minor Consent

Should you need to give permission for another person to consent to evaluation and treatment of your minor child, please use the following form.

Consent for Treatment of Minor Patient

If you need to consent to various treatments for your minor child, please use this form.


Minor Consent Form

Health Care Directives

If you wish to identify health care agents to make health care decisions for you when you are not able to do so yourself, use these forms.

Minnesota Health Care Directive

Minnesota Health Care Directive (for adults with chronic or serious illness)

Should you have any other questions about your medical records, our Medical Records office is located at our Professional Building (111 SE 3rd Street, Grand Rapids, MN). In-person record requests and pick-ups are available Mondays and Thursday from 8:00 AM - 4:30 PM. You may also contact us at 218-999-1500 or by fax at 218-999-1512.