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If you would like to request a copy of your medical records, please download the Release of Information Authorization form.

Health Information contained in the patient medical record may only be disclosed with the authorization of the patient or their appointed representative. You will need to sign this form and return it to our Health Information Management department before we can release your medical records to anyone.

Please allow 24 to 48 business hours for processing your request. We can mail your medical records to you, or you or a third party may pick them up at Western Wisconsin Health. Medical records cannot be faxed due to lack of confidentiality.

To complete the 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
Baldwin, Wisconsin 54002
Phone: 715-684-8620
Fax: 715-684-8632

Please remember to attach a copy of your photo ID.

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