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Minnesota Health Records Act supplement and consent form

Granite City Family Dental — Policy set version 1.0 — Effective November 1, 2026 — Binder edition 2026

Authority: Minn. Stat. 144.291–144.298 (Minnesota Health Records Act); 144.2925 (construction with HIPAA); 144.292 (patient access and copy charges); 144.293 (release or disclosure of health records); 144.294 (records relating to mental health); 144.298 (penalties and liability).

Approved by Dr. Maria Lindqvist, Owner. Responsible officer: Janelle Okafor, Office Manager. Release-of-information processor: Janelle Okafor.

Purpose

Minnesota law is stricter than HIPAA about releasing health records. Under HIPAA a provider may share records for treatment, payment and health care operations without the patient's signature; under Minn. Stat. 144.293 most releases by a Minnesota provider, including routine provider-to-provider treatment disclosures outside a related health care entity, require the patient's signed and dated consent. Minn. Stat. 144.2925 states that the Minnesota Health Records Act is to be construed more stringently than 45 CFR Part 164 wherever the two differ, so at Granite City Family Dental the release process must satisfy both laws, and where they differ, Minnesota's rule is followed.

1. Consent for release — Minn. Stat. 144.293

When consent is required

A health record, or information from it, is released only with the patient's signed and dated consent, or the consent of a person legally authorized to act for the patient, unless an exception below applies. This includes releases to other providers, specialists, attorneys, employers, schools, insurers (beyond what payment requires under the patient's coverage) and family members.

What a valid consent contains

The consent is in writing, signed and dated by the patient or authorized person, and specific enough to identify:

  • the patient;
  • the provider releasing the records (Granite City Family Dental);
  • the person or organization receiving them;
  • the records or the kind of information to be released;
  • the purpose of the release;
  • when the consent expires. At Granite City Family Dental a consent is valid for 12 months from the date of signature unless the patient writes a shorter or longer period on the form or revokes it earlier. Minnesota law treats a consent as valid for one year unless it specifies otherwise, or for a different period when the patient is receiving ongoing treatment or the release concerns a legal claim.

A general consent that does not name what is released and to whom is not sufficient. A HIPAA authorization form (document 08) is accepted only if it contains every element above.

Exceptions — release without a separate consent

  • Emergency. When the patient cannot consent and the information is needed for emergency treatment.
  • Related health care entities for current treatment. Records may be shared within a related health care entity for treatment of the current condition without a separate consent. Related entities named by Granite City Family Dental: None. Because none is named, every disclosure to another provider for treatment requires consent unless another exception applies.- Representation of consent. A record may be released to another provider on that provider's written or documented representation that it holds the patient's signed consent for the release; the representation is kept in the chart.
  • Specific legal authorization. Releases required or permitted by a specific Minnesota or federal law (public health reporting, abuse reporting, court orders, subpoenas handled under document 07).
  • Record locator or patient information service. Granite City Family Dental does not participate in a record locator service or health information exchange. If it joins one, this section and the Notice of Privacy Practices are updated first.- Patient's own access under section 2.

Mental health records — Minn. Stat. 144.294

Records relating to mental health are released under the same consent rule. A provider may withhold information from the patient only when the provider reasonably determines the information is detrimental to the patient's physical or mental health or likely to cause the patient to harm self or others; the reason is documented and the information is released to a third person the patient chooses.

Documentation in the chart — Minn. Stat. 144.293 subd. 9

For every release the practice records in the patient's chart: the date of the release, what was released, to whom, the purpose, and the authority for it (the consent on file, or the exception relied on). The signed consent form is scanned into the chart and kept at least as long as the record. This documentation also feeds the HIPAA accounting of disclosures where that applies (document 09).

2. Patient access and copy charges — Minn. Stat. 144.292

  • On a written request, a patient (or an authorized person) receives a copy of their complete record, or a summary where the patient agrees, promptly. The practice's turnaround target is 10 days, and in no case later than HIPAA's 30 days.
  • Copy charges may not exceed the per-page and retrieval limits in Minn. Stat. 144.292, subd. 6, as adjusted annually by the Commissioner of Health, and no charge is made for copies needed to continue the patient's care or to appeal a denial of benefits. The practice's fee schedule: Electronic copies to the patient: no charge. Paper copies: actual cost of labor and supplies, not exceeding Minnesota Statutes 144.292 limits. No fee for records needed to continue care or to appeal a benefit denial.
  • Fee schedule checked against 144.292 this year: Yes.- Minnesota requires the practice to make the record available in the form requested where it is readily producible, consistent with HIPAA's right of access (document 09).

3. Release-of-information workflow

Requests are logged on receipt; the consent is checked for signature, date, scope and expiry; identity is verified; the release is documented in the chart with date, recipient and what was sent; copies go out by the method the patient chose.

  • Identity is verified using the methods in document 07 (Government photo ID in person, Date of birth plus address or phone on file (phone requests), Signed written request matching signature on file and Guardianship or power of attorney papers).
  • A consent that is unsigned, undated, expired, or does not name the recipient or the records is returned to the requester; the record is not released on a defective form.
  • Releases are logged in the patient request log (document 09) with the date received and the date completed.
  • A patient may revoke a consent in writing at any time; the revocation is scanned into the chart and stops any further release from that date.

4. Minnesota consent form

Granite City Family Dental already uses a Minnesota-compliant consent; the form on the next page is the binder's standard version and may replace it. The Privacy Officer confirms once a year that the form in use contains every element in section 1.

5. Liability — Minn. Stat. 144.298

A person who negligently or intentionally releases a health record in violation of the Minnesota Health Records Act, or who requests one under false pretenses, is liable to the patient for compensatory damages plus costs and reasonable attorney fees, and a licensed provider may face discipline by the licensing board. Workforce members are trained on this policy; violations are handled under the sanction policy (document 05).

Approval

Policy approved by: Dr. Maria Lindqvist, Owner Signature: ___________________________ Date: ______________

Privacy Officer: Janelle Okafor Signature: ___________________________ Date: ______________

Minnesota Consent for Release of Health Information

Granite City Family Dental 412 2nd Street South, St. Cloud, MN 56301 — Phone 320-555-0142 — Fax 320-555-0143 This consent is made under the Minnesota Health Records Act (Minn. Stat. 144.293) and the HIPAA Privacy Rule (45 CFR 164.508).

Patient

Patient name: __________________________________________ Date of birth: ______________

Address: __________________________________________ Phone: ______________

I authorize Granite City Family Dental to release the following records:

☐ Complete record for dates of service ______________ to ______________

☐ Visit notes / progress notes

☐ Laboratory and test results

☐ Imaging reports

☐ Medication list and prescriptions

☐ Immunization record

☐ Billing records

☐ Other: __________________________________________

Information that requires a specific check to be released: [ ] Mental health records [ ] Chemical dependency / substance use treatment records (federal rules under 42 CFR Part 2 may also apply) [ ] HIV / AIDS-related information [ ] Genetic testing information

To (recipient):

Name / organization: __________________________________________

Address: __________________________________________

Phone: ______________ Fax: ______________ Email or portal: __________________________________________

Purpose of the release: [ ] Continuing care / treatment [ ] Insurance or benefits [ ] Legal [ ] Personal use [ ] Other: ______________

Method of delivery: [ ] Paper by mail [ ] Pick up in person [ ] Secure electronic (portal / encrypted email) [ ] Fax to the number above [ ] Direct transmission to the provider above

Expiration. This consent expires on ______________ (date or event). If no date is written, it expires 12 months from the date signed.

My rights. I understand that:

  • I may revoke this consent at any time by writing to Granite City Family Dental; the revocation does not affect information already released.
  • My treatment, payment, enrollment or eligibility for benefits will not be conditioned on signing this consent, except where the law allows.
  • Information released under this consent may be re-disclosed by the recipient and may no longer be protected by federal or Minnesota privacy law.
  • I may see and copy the information described, and I may have a copy of this form.
  • Granite City Family Dental may charge a reasonable copy fee for records released for purposes other than continuing care or a benefits appeal, within the limits of Minn. Stat. 144.292.

Signature of patient or authorized person: ___________________________ Date: ______________

Printed name: __________________________________________

If signed by someone other than the patient, relationship and authority (parent of minor, guardian, health care agent, personal representative; attach papers): __________________________________________

Witness (practice staff): ___________________________ Date: ______________

For office use — Identity verified by: ______________ Released on: ______________ What was sent: __________________________________________ By: ___________________________ Documented in chart: [ ] Yes