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Gerten Urogynecology fax number
(952) 920-0866
Wrong or outdated? Report this number
Records Release
Used for: Medical records release / records request
Fax destination details
- Department
- Records Release
- Purpose
- Medical records release / records request
- Form
- PATIENT RECORD RELEASE FORM — Patient Record Release Form
- Address
- 6565 France Ave S, Suite 300, Edina, MN 55435
- Voice phone
- (952) 924-8671
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Complete all sections (1-6) on GER-941_ROI; specify which records to release (office notes, radiology, lab, pathology, billing, etc.); indicate dates of service; state the reason for the request; provide recipient information; sign and date. Return via mail, drop off, or fax to the provided address. A fee may apply for releasing records. The form expires after one year from the date signed unless otherwise specified. Electronic signatures are not accepted.
Official form instructions are published as a downloadable file on the organization's website.
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