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.
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
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, 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.