To obtain your medical records, please submit a completed Release of Information Form. The form can be sent to ROI by mail, fax, e-mail or dropped off in person.
In certain cases, the patient’s physician or psychologist may also be required to approve a request before the healthcare information is released.

• Fill in your name, address, phone number and date of birth
• In the Information to be released section, specify what records you are requesting
  • Specify dates of service and what records (e.g. immunization record, knee treatment, Cardiology records, etc.)
• Select your preference in the Method of Release and Method of Delivery sections
• If Mental Health or Chemical Dependency records are being requested, complete the box in the middle of the page. Be sure to sign and add the date and time.
• In the Release To section, enter the information for who/where the records are to be released to. The following parts are required
  • Name/Facility
  • Address
  • City/State
  • Phone
  • Fax (if you selected fax as the method of release)
  • E-mail (if you selected e-mail as the method of release)
  • Sign the bottom and add the date and time

• Patient (18+ years of age)
• Parent (under 18) – a Step-parent cannot sign
• Legal Guardian – Legal paperwork must be submitted with the Release of Information Form
• Power of Attorney (if the patient is incapacitated) – Power of Attorney paperwork must be submitted with the Release of Information Form

NOTE: Trinity Health does not accept electronic signatures

Hours of Operation

Monday thru Friday, 8 a.m. to 5 p.m.

Mailing address

Trinity Health ROI
P.O. Box 5020
Minot, ND 58702

Physical Address

407 3^rd St. SE
Take the main elevator to 3^rd Floor
Photo ID required

Phone Number

701-857-5390
After Hours: 701-857-2446

Fax Number

701-857-5778 or 701-857-7879

E-mail Address

Trinity.ROI@trinityhealth.org

Medical Records dating back to 2014 are available on Trinity Health’s Patient Portal. To sign-up for the Patient Portal, you can complete the sign-up form in-person at your next doctor’s appointment or at the Release of Information office.

Once the Release of Information is received, the release process may take up to 30 days. All requests are processed in the order they’re received and Trinity Health ROI strives to process requests as quickly as possible while still maintaining confidentiality.

The requested records will be delivered in the method chosen on the Release of Information Form.

NOTES:

• Records can only be faxed if there are 50 pages or less. If there are more than 50 pages, the records will be mailed.
• There is a file size limitation on e-mail. If the file is too large, the records will be mailed.
• Unsecure E-mail – Health information sent via unsecure e-mail may be at risk of inappropriate access. By selecting this option on the Release of Information Form, you are accepting this risk.

A COVID vaccination card is a one-time thing provided when you receive your vaccinations. They cannot be re-created.

Release of Information can provide a full immunization record that does include the COVID vaccinations.

Specify on the Release of Information Form that you would like Radiology Images.

The Imaging will be provided on a CD and can be mailed or picked up.

• Images going to another facility that is linked to Trinity Health can be pushed electronically. (most ND facilities and Mayo Clinic)

Specify on the Release of Information Form that you are requesting Billing. ROI can direct the release to Billing for processing, or you can send the Release directly to the Billing office.

Trinity Health Billing
P.O. Box 5010
Minot, ND 58702
Clinic Billing Phone: (701) 857-5650
Hospital Billing Phone: (701) 857-5105
Fax: (701) 857-3011

If there is an executor of estate, the executor must sign and submit the Release of Information Form. A copy of the legal documents naming the executor and a copy of the death certificate is also required.

If there is no executor of the estate, then the patient’s next-of-kin can sign and submit the Release of Information Form. A copy of the death certificate is required.

In some situations there is a charge for the release of medical records. Please review the ROI Price list under Forms. (Right side of the page)

The cost of records cannot be determined until after the request is processed and the number of pages is determined. Once the request has been processed, an ROI Specialist will contact you via phone, e-mail, or mail with the amount due. Payment can be made by Cash, Check, Credit Card, or Money Order.

Complete a PHI Amendment Request form (found under Forms on the right) and submit it to Release of Information.

Once received, your request and chart will be reviewed. For more information on the process, please review the PHI Amendment FAQ on page 2 of the form.

Birth Certificates are issued by the ND State Department of Vital Records

https://www.health.nd.gov/vital

Phone: (701) 328-2360

Address

ND State Department of Health
Division of Vital Records
600 East Blvd Ave
Bismarck, ND 58505-0200