Patient Medical Records

The results of all laboratory tests, X-rays, other diagnostic studies, and medical treatment you have received while you are hospitalized or treated as an outpatient are documented. Also included are physician reports from examinations, general surgery, treatment and medications, and observations by nurses and other members of your health care team. This information is combined to make up your medical record.

If you have any questions regarding copies of your medical records, please contact the Medical Records Department at (218) 666-6213.

Obtaining Copies of Your Medical Records

Release of Information (ROI)

Records can be released to anyone that the patient authorizes (in writing). A valid authorization MUST contain the following information or the request will be returned:

  • Patient’s full name, address, phone number, and date of birth.
  • Specification of Cook Hospital as the facility to release the information.
  • Name of facility, company or person to receive the information.
  • Specification of approximate dates of service or illness for which information is requested, (“all is not sufficient”).
  • Specification of the purpose for the request of information.
  • Signature of patient or authorized representative. Authorized representative must include a description of their authority to act on behalf of individual. Patient or authorized representative must be able to verify their identity through legal documentation, such as a driver’s license.
  • Date of patient signature.

When requests for medical records of a deceased patient are made, a death certificate must be presented to identify the next of kin. The next of kin in this situation can authorize release of the information. Identification should be verified with a picture ID such as a driver’s license.

Requests for medical records may be mailed or faxed to:
Cook Hospital
Medical Records Department
10 Fifth Street S.E.
Cook, MN 55723
Fax: (218) 666-6238

Medical Record Release Form

Authorization for Release of Medical Information: This PDF form is to be used when the patient or designated individual is requesting their Cook Hospital health information be sent to someone outside the institution or to themselves.

Fees

For continuation of care, a “pertinent packet” of you medical information will be sent free of charge to a physician or medical facility. This packet consists of recent discharge summaries, letters, procedure notes and diagnostic testing results. Patients may receive up to 25 pages of their medical record information at no charge. If the requested information is older than a year and/or is more than 25 pages, the requestor may be charged $1.18 per page with an included retrieval fee of $15.44.

Some records requested for legal, insurance, or personal use may require a prepayment. If your request requires a prepayment, a fee notice will be sent to you upon receipt of your request.

Death Certificates

The Cook Hospital does not provide copies of death certificates. For information on how to obtain a copy of a death certificate, please contact the County’s Registers Office.

Privacy Policy

The following notice describes how medical information about you may be used and disclosed and how you can get access to this information.

View Privacy Policy »