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.
Please complete the appropriate form to request and send a copy of your record to yourself, using the Patient Access Request for Health Information.
Someone other than yourself, using 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.
Receiving your Health Information:
You have choices on how to receive your health information, including:
- MyChart, a free online portal to your information
- Email (encrypted or unencrypted*)
- USB (encrypted or unencrypted*)
- CD (radiology images only)
* If you choose to receive information in an unsecure manner, the information will not be encrypted, and it could be viewed by a third party. WWH is not responsible for the unauthorized access of your health information while in transmission.
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 allow 7 business days to process your request.
At Western Wisconsin Health we utilize MyChart, a free online patient portal powered by Allina Health. This is a secure online health information management tool that connects Western Wisconsin Health patients, along with Allina Health and its affiliates to portions of their electronic medical record, allowing you to view clinical information online. This information includes allergies, immunization, past and upcoming appointments, progress notes, and lab & radiology results. CLICK HERE TO LEARN MORE.
This notice provides a clear, user-friendly explanation of individuals’ rights with respect to your personal health information and the privacy practices of health care professionals at Western Wisconsin Health specific to how we will use and disclose your information. CLICK HERE TO LEARN MORE.
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
Office hours: Monday through Friday 8 am – 4:30 pm
Additional Registration forms available for download:
- Assignment of Benefits (consent to treat)
- Consent for Use and Release of Health Info
- Electronic Health Record
- Consent to Treat Minor/Other
To complete the forms:
Click the link above and print the form.
Please return the completed form by mail, email, fax, or in-person to the Health Information Department.
Please remember to attach a copy of your photo ID for proper identification purposes.
Please submit necessary paperwork related to FMLA/Disability by dropping off at Clinic registration desk, mailing, emailing or faxing. Please allow us 5-7 business days to complete paperwork.
When submitting paperwork an AUTHORIZATION FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION form MUST be completed for us to properly release your paperwork.
Mail: 1100 Bergslien Street, Baldwin, WI 54014
*If you are wanting your paperwork faxed/submitted to the company/employer, please ensure you put that information on the authorization, or we cannot release it to the company due to HIPAA.
*If the AUTHORIZATION FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION form is not completed there will be a delay in the return or submission of paperwork.
*If you have any question relating to FMLA/Disability paperwork please contact Cayla at 715-684-1283 or call the Main phone number at 715-684-1111.