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Patient Forms
- Disclosure of Health Information Authorization
If you would like copies of your health record, please
print out a copy of this form. Please FAX your completed
form back to our confidential Health Information
Management fax machine at (608) 930-7261. Please
indicate the date you need copies of your records. On
step #5, please include the complete name and address
of those who should receive the information.
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800
Compassion Way • PO Box 800 • Dodgeville, WI 53533-0800
608-930-8000 • Fax: 608-930-7250 • TDD 608-935-0008 |
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