If your child has a
life-threatening emergency,
call 911 immediately.

Call the Main Line for
Appointments, Urgent Issues
and Triage Nurse

Health Information Management

(also known as Medical Records)

When a child is injured or ill, paperwork is often the last thing on a parent’s mind. That’s why the South Lake Pediatrics staff is always here to help assist you with your medical records needs. From finding the proper forms to facilitating medical record transfers, we’ll guide you through every step and make the process as simple and convenient as possible.

How you can help:
Please complete your portion of any health, daycare, camp or sports form before dropping it off at our office and allow two weeks for turnaround.

If a minor’s records are to be sent to another clinic or an insurance company, the legal parent or guardian of the patient must first complete our Release of Medical Information Form and fax it to 952-401-8242. Or, you may choose to mail or drop it off at any of our six convenient locations. We can only release records that were created during your visit here at South Lake Pediatrics. All patients 18 years of age and older must complete their own form.

If you have any questions, please contact us by email or by calling 952-401-8265.

Some of the medical forms you might need can be found under our Health Info tab. Please fill these forms out and bring them to your scheduled appointment.


Frequently asked questions: 

How long are medical records kept?

Medical Records will be preserved until the patient is at least 28 years of age or longer depending on the date on which the patient was last treated at any of our South Lake Pediatrics facilities.

Who is authorized to sign for release of medical records?

The authorization must be signed by the patient, a parent of the patient (if the patient is a minor), or the patient’s legally empowered representative.

What is the turn around time to process a request of records?

South Lake Pediatrics asks for 10-14 business days to process the request; however we do take them in the order they are received. If the patient has an upcoming appointment with another provider, we ask that you include that information on the request form.

Is there a charge to request copies of medical records?

There is a $16 minimum charge for personal copies of medical records as well as copies sent to law firms and insurance companies. A prepay count will be prepared and provided to the requester prior to sending. The charge is based on the number of pages requested and is charged according to Minnesota and North Dakota statutes. There is no charge if your records are being sent directly to another healthcare provider.

Is there a charge to request copies of X-ray images?

Not if the X-ray images are used for continual care from provider to provider. This would include the patient/parent hand carrying the CD to the provider.

When you send records to another facility, do you send copies or the original? Will there still be information at South Lake Pediatrics if I return as a patient?

The medical records itself is a legal document and the property of South Lake Pediatrics. Therefore, the original medical record stays at South Lake Pediatrics and copies are sent to the other facility.

What type of records will be sent?

The standard guideline for releasing records includes: a complete copy of the patient’s growth chart and immunization record, along with the last 2 years of office visits and 1 year of lab and x-ray. If there is an ongoing issue additional information can be released to the provider at their request.

Who can pick up medical records?

If someone other than the biological parent or patient (if 18 years of age and older) will be picking up copies of medical records, written authorization from the patient/parent must be presented before we can release them. Personal identification may be required for all pick-ups.







Contact Us

Health Information Management

Phone # 952-401-8265
Fax # 952-401-8242

South Lake Pediatrics
Attn: HIM Department
17705 Hutchins Dr #250
Minnetonka MN 55345