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PO Box 399 Stanley, ND 58784 Phone 7016282424 (hospital) Phone 7016282505 (clinic) Fax 7016283823Authorization for Release of Protected Health InformationPatient Name: Former Name: Date of Birth:
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Mountrail County Medical Center is a healthcare facility located in Mountrail County.
Healthcare providers and facilities in Mountrail County are required to file.
The form can be filled out online or submitted in person at the medical center.
The purpose is to collect and report healthcare data for Mountrail County.
Information such as patient demographics, medical treatments, and outcomes.
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