Records or Forms

Getting Medical Records from Western Wisconsin Health

Medical information is confidential and protected by law. While the information belongs to the patient, Western Wisconsin Health owns the record. The information can only be released with authorization from the patient or their legal guardian. The law requires that the authorization include the patient’s signature and the date the request is being authorized. Please complete the Authorization for Disclosure of Protected Health Information Form.

Permission to Discuss Protected Health Information

We understand the importance of privacy when it comes to your health information. If you’d like certain family members, friends or others to be involved in your care, please complete the Written and Verbal Authorization. This will let us know who you would like us to talk to regarding lab and test results, treatment information, and other medical information that you authorize.

Need Help?

Contact our Release of Information Department and we’ll help you obtain your medical records.

Western Wisconsin Health
Health Information Management Department
1100 Bergslien Street
Baldwin, Wisconsin 54002

Phone: 715-684-1590
Fax: 715-684-1594

Additional Registration forms available for download:

To complete the forms:

Click the link above and print the form.

Please return the completed form by mail, fax, or in-person to the Health Information Department.

Cost & Charges

In some cases, there is a cost associated with the retrieval and copying of medical records. You will be informed upfront if you will be responsible for any charges.

Please remember to attach a copy of your photo ID.

Immunization Records keyboard_arrow_down

The Wisconsin Immunization Registry (WIR) is a computerized Internet database application that was developed to record and track immunization dates of Wisconsin’s children and adults, providing assistance for keeping everyone on track for his or her recommended immunizations. Statewide release occurred in May 2000. All demographic information for births occurring in Wisconsin were back loaded to January 1995 and continue to be downloaded on a weekly basis.

By keeping a record of the immunizations given, health care providers, parents and legal guardians know if and when a child had been given a vaccine. This helps with keeping children up-to-date on all needed vaccines.

Public Immunization Record Access gives people the ability to look up immunization records in the Wisconsin Immunization Registry. If you want to use this feature, you must perform a search for the record using first name, last name, date of birth, and one of either social security number or Medicaid ID.

The system looks for a record that matches all the data you have entered. It will display a list of immunizations the person has received. The system will also list the vaccines the person currently needs.

It is possible that the system will be unable to find the record you are looking for. Please check the spelling and format of the data you have entered for each field.

If you are still having trouble, it may be because the social security number or Medicaid ID for the person has not been stored in the registry. Please contact your health care provider at the clinic or heath care facility that you go to for immunizations.

To access the Wisconsin Immunization Registry click here.

If You Have Questions

If you have questions about the Wisconsin Immunization Registry, speak to your health care provider or you may visit: www.dhfswir.org or www.dhfs.wisconsin.gov/immunization.