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The following consent forms are available for download:

Assignment of Benefits Consent

Consent for Release and Combining of Health Records Among Health Care Providers

Consent for Release of Information

Release of Health Information Authorization Form

To complete a form:

  • Click the link above and print the form.
  • Please return the form by mail or fax, or drop it off to the Health Information Department.

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

Phone: 715-684-1111

Please remember to attach a copy of your photo ID.

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