Forms

Below is an archive of accessible forms for the convenience of patients, providers and referrents. These are categorized by type of form, and some forms can be found in multiple locations. This page also includes Frequently Asked Questions (FAQ) and other informational flyers. If you have any questions, please contact us at 952-826-8475.


New Patient Forms

Download Admissions Packet
Download Adult Clinic Appointment Packet
Download Child Clinic Appointment Packet
Notice of Privacy Practices
Submit Forms Through Our Secure Email Messaging Service


Financial Forms and Information


Release of Information (ROI)

To request your (or your child’s) medical records:

from Inpatient or Partial Hospital Programs to another provider click here:
PrairieCare Request to Release Information (Hospital or PHP)

from Clinic or IOP visit to another provider click here:
PrairieCare Medical Group Patient Request for Medical Records (Clinic or IOP)

from Inpatient or Partial Hospital Program visit to be sent to you click here:
PrairieCare Patient Request for Medical Records (Hospital or PHP)

from Clinic or IOP visit to be sent to you click here:
PrairieCare Medical Group Request for Medical Records (Clinic or IOP)

To give authorization to share your (or your child’s) medical records / school information from:

PrairieCare Inpatient or Partial Hospital Program visit with your (or your child’s) school district click here:
PrairieCare School Release of Information

PrairieCare Inpatient or Partial Hospital Program visit with your family or designated person click here:
PrairieCare Release of Information for Family Involvement

PrairieCare Clinic or IOP visit with your family or designated person click here:
PrairieCare Medical Group Family Involvement Release of Information


Privacy and Confidentiality Forms


Referral/ Provider Form


Frequently Asked Questions (FAQ’s)


Other Helpful Information