Patient Forms

St. Alexius Medical Center and Clinic Patient FormsSt. Alexius Medical Center and Clinic Patient Forms

To Download your form of choice, please CLICK on the document below.

Advanced Directives
Advanced Directives

Medical Records
Authorization of Release of Information

1. St. Alexius Medical Center and Clinics have separate and distinct medical records.

A. St. Alexius Medical Center Hospital inpatient and outpatient records are maintained by the Hospital Medical Record Department located on the first floor of the medical center in the administrative hallway. Examples of outpatient records maintained by the Hospital Medical Record Department are emergency room records, outpatient surgery records, same day surgery center records, etc.

B. St. Alexius Heart & Lung Clinic maintains the record for all of their provider office visits. Requests for Heart & Lung Clinic medical records can be directed to that clinic's reception desk on the second floor. Take elevator D to second floor.

C. The Clinics of St. Alexius (formerly known as Specialty Clinics) maintain the record for all of their provider office visits. Requests for The Clinics of St. Alexius medical records can be directed to that clinic's third floor reception desk. Take elevator D to third floor.

D. St. Alexius Center for Family Medicine Mandan records are maintained at the clinic in Mandan.

E. St. Alexius Minot Medical Clinic records are maintained at the clinic in Minot.

F. Archway Mental Health Services maintains the record for all Archway provider office visits. Requests for Archway medical records can be directed to that clinic's reception desk.


2. Depending on the services you have received throughout St. Alexius Medical Center and Clinics, it may be necessary to contact the separate areas to get all the records you need. Any one of our medical record departments and/or clinics would be happy to coordinate this for you, upon request.

A. If you have been a patient in the hospital, either as an inpatient or as an outpatient, regardless of the physician who provided your care, your record will be available in the hospital Medical Record Department.

B. For all clinic care that you receive, those records will be available in the clinic where you received care.


3. Mid Dakota Clinic, a member of Primecare, but not a St. Alexius owned clinic, maintains their clinic records at the Mid Dakota Clinic. If you need records for clinic care provided at Mid Dakota, please contact the Mid Dakota Clinic Release of Information Nurse.

Authorization for Release of Information

1. Download Form - Authorization of Release of Information

2. Complete the Authorization for Release of Information form in its entirety. Be sure to include all entities of St. Alexius where records are needed. Be sure you sign and date the form. If you need assistance completing the form, feel free to contact:

A. Hospital Medical Record Department - (701) 530-8935

B. Heart & Lung Clinic - (701) 530-7410

C. The Clinics of St. Alexius (formerly Specialty Clinics) - (701) 530-6628

D. Center for Family Medicine Mandan - (701) 530-4608

E. Minot Medical Clinic - (701) 858-1800

F. Archway Mental Health Services - (701) 530-7333


3. You may present your completed form to the appropriate area as defined above. Or you may send the completed form by email, fax, or by mail as directed below. If you are emailing the form, you must scan the completed document and attach it to your email. The above form is not interactive.


A. Hospital Medical Record Department
Email: lohopfauf@primecare.org
Fax: 701-530-8984
US Mail: St. Alexius Medical Center
Health Information Management Department
Post Office Box 5510
Bismarck, North Dakota 58506-5510

B. Heart & Lung Clinic
Email: hlcmedrecords@primecare.org
Fax: 701-530-7560
US Mail: St. Alexius Heart & Lung Clinic
Medical Records
Post Office Box 2698
Bismarck, North Dakota 58502-2698

C. The Clinics of St. Alexius (formerly Specialty Clinics)
Email: staclinicsroi@primecare.org
Fax: 701-530-6586
US Mail: The Clinics of St. Alexius
900 East Broadway
Bismarck, North Dakota 58501

D. Center for Family Medicine Mandan
Email: nbullinger@primecare.org
Fax: 701-530-4605
US Mail: Center for Family Medicine Mandan
403 Burlington Street Southeast
Mandan, North Dakota 58554

E. St. Alexius Minot Clinic
Email: panorman@primecare.org
Fax: 701-857-8056
US Mail: St. Alexius Minot Clinic
2700 8th Street Northwest
Minot, North Dakota 58703

F. Archway Mental Health Services
Email: sgleich@primecare.org
Fax: 701-530-7305
US Mail: Archway Mental Health Services
Medical Records
Post Office Box 5510
Bismarck, North Dakota 58506-5510