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.

OR

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
  • Paper
  • 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.

Turnaround Time

Please allow 7 business days to process your request.

Patient Portal

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.

Privacy Practices

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.

Need Help?

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:

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.

FMLA/Disability Paperwork

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

Email: ClinicCareTeam@wwhealth.org

Fax: 715-684-1245

*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.

The Wisconsin Immunization Registry (WIR) is a computerized Internet database application that was developed to record and track immunization dates of Wisconsin’s children and adults, providing assistance for keeping everyone on track for his or her recommended immunizations. Statewide release occurred in May 2000. All demographic information for births occurring in Wisconsin were back loaded to January 1995 and continue to be downloaded on a weekly basis.

By keeping a record of the immunizations given, health care providers, parents and legal guardians know if and when a child had been given a vaccine. This helps with keeping children up-to-date on all needed vaccines.

Public Immunization Record Access gives people the ability to look up immunization records in the Wisconsin Immunization Registry. If you want to use this feature, you must perform a search for the record using first name, last name, date of birth, and one of either social security number or Medicaid ID.

The system looks for a record that matches all the data you have entered. It will display a list of immunizations the person has received. The system will also list the vaccines the person currently needs.

It is possible that the system will be unable to find the record you are looking for. Please check the spelling and format of the data you have entered for each field.

If you are still having trouble, it may be because the social security number or Medicaid ID for the person has not been stored in the registry. Please contact your health care provider at the clinic or heath care facility that you go to for immunizations.

To access the Wisconsin Immunization Registry click here.

If You Have Questions

If you have questions about the Wisconsin Immunization Registry, speak to your health care provider or you may visit: www.dhfswir.org or www.dhfs.wisconsin.gov/immunization.

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