January 2012
Office of Health Information Technology
PO Box 64882
St. Paul, MN 55164-0882
651-201-3598
Standard Consent Form to Release Health Information
Background
In 2007, revisions to the Minnesota Health Records Act
(HRA), (Minnesota Statutes sections 144.291 – 144.298)
were passed by the Minnesota Legislature. A key
provision of the updated HRA was a mandate for the
Commissioner of the Minnesota Department of Health to
develop a standard consent form to access health records
(Minnesota Statutes 144.292, subd. 8).
T
he Minnesota Department of Health looked to the
Privacy and Security Workgroup of the Minnesota e-
Health Initiative to help develop the Minnesota Standard
Consent Form. The workgroup membership consists of
provider organizations, legal experts and privacy
advocates. The form was developed based on workgroup
expertise and existing consent forms. The form represents
current privacy and confidentiality business practices and
is compliant with current federal and state privacy law.
Questions and Answers
Q – What does the Minnesota HRA say about the need for
the consent to release health records?
A - The Minnesota HRA generally requires a patient’s
consent to release health records. There are exceptions
such as in the case of medical emergencies.
Q
- What is the purpose of the form?
A - To have a standard form for patients or their legal
representative to provide consent to release patient’s
health records and send them to who they choose for
whatever purpose they choose.
Q
– Who can use this new form?
A - Any patient or legal representative of a patient, health
care provider or organization can use the form.
Q
– Are organizations required to replace their own
consent form with this Standard Consent Form?
A - The Standard Consent Form does not replace
organizations’ existing consent forms to release health
information. If an organization chooses to replace their
existing forms, they can adopt this form in whole or in
part.
Q – Are organizations required to accept this form?
A - If a person elects to use this form, to
request the
release of his or
her health records and completes it
properly, it is a legally
enforceable request and
organizations must honor it.
Q – Does this form consider other consent requirements
besides the Minnesota HRA?
A - Yes,
when the form was created all current state and
federal consent requirements to release health records
were considered such as HIPAA 45 CFR section 164.508,
42 CFR and Minnesota Statutes sections 144.291-.298,
13.05, 13.386 and 72A.501.
Q – What are some of the benefits of a standard consent
form to release health records?
A - When properly completed it is a legally enforceable
request and it can be relied on because
it is compliant with
all
current state and federal requirements to release health
records.
Q – What is the reading level of the form and
instructions?
A - Currently, the form and instructions are at a 10
th
grade
reading level according to
the Flesch-Kincaid Grade Level
readability test.
Q – Is the form available in other languages?
A – It is currently not
available in other languages.
Q – Are the form and instructions available in an
electronic format?
A - Yes,
the form is currently available online at:
www.health.state.mn.us/facilities/ehealth/privacy/index.html;
it av
ailable as a writable PDF or can be printed. It is
important to read the instructions before using the form as
incomplete forms may not be accepted.
For more info
rmation, contact:
Office of Health Information Technology
http:/www.health.state.mn.us/facilities/ehealth/index.html
651-201-3598
