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Records or Forms

The following consent forms are available for download:
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

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

Please remember to attach a copy of your photo ID.

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