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Patient Records Request

You have the right to see information in your health record. Your health record includes your medical history, health insurance information and how to contact you. You can request your health record information either electronically using MyChart, our online patient portal, or by completing and sending the appropriate paper form.

Requesting Medical Records

Requesting Medical Records Request your medical records by visiting MyChart, our online patient portal.

Or, request your medical records by printing and completing the Authorization for Disclosure of Protected Health Information Form. Fax your completed form to (701) 873-4199 or mail to:

CCCHC
1312 Hwy 49 N
Beulah, ND 58523

Authorization for Disclosure of Protected Health Information


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Requesting Medical Records

If you have additional questions please contact our Medical Records Department by phone at (701) 873-4445.