Allina Authorization Form
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Web authorization for release of protected health information (phi) (third party) autorización para divulgar información protegida de salud request for protected health information. View a list of services and drugs that require prior authorization. Web if you wish to view information prior to selection of documents, please identify this on the authorization form and we will contact you to set up a viewing appointment. 49000 allina health customer experience center, 8880 evergreen blvd, coon rapids, mn 55433 or fax to: