Access to things that matter most.
For Patients & Visitors
Medical Record Forms
If you're a Mayo Clinic Health System patient or have been one in the past, you can use these forms to grant permission for others to access your protected health information or request a change to your health record.
Grant access to your protected health information
Complete and submit the appropriate authorization form below:
- English adult: Authorization to Disclose Protected Health Information to Family and Friends Adult Patient
- English child: Authorization to Disclose Protected Health Information to Family and Friends Minor Child
- Spanish adult: Autorización para revelar información médica confidencial a familiares y amigos Paciente adulto
- Spanish child: Autorización para revelar información médica confidencial a familiares y amigos Menor de edad
Authorize the release of information
The Authorization to Release Protected Health Information to a Third Party form is used to authorize the release of health information for insurance, employment, legal or corporate health purposes. It's used by patients to transfer records from another health care facility to Mayo Clinic Health System.
- Arabic: التخويل باإلفصاح عن بيانات صحية
- English: Authorization to Release Protected Health Information to a Third Party
- Hmong: Kev Tso Cai rau Tso Tawm Cov Ntaub Ntawv Fab Kev Kho Mob Uas Raug Tiv Thaiv mus rau Tog Neeg Thib Peb
- Somali: Oggolaanshaha in Loo shaaciyo Macluumaadka Ilaashan ee caafimaadka Kooxda saddexaad
- Spanish: Autorización para revelar información médica confidencial a un tercero