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

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

Please remember to attach a copy of your photo ID.