Records or Forms
The following consent forms are available for download:
- Release of Health Information Authorization Form (RECORDS)
- Assignment of Benefits Consent
- Consent for Release and Combining of Health Records Among Health Care Providers
- Consent for Release of Information
- Notice of Privacy Practices
To complete the form:
- Click the link above and print the form.
- Please return the completed form by mail, fax or in person to the Health Information Department.
Western Wisconsin Health
Health Information Management Department
1100 Bergslien Street
Baldwin, Wisconsin 54002
Please remember to attach a copy of your photo ID.