medical records request
To request records please email firstname.lastname@example.org or call 715-463-7240. In order to authorize the release of records to someone other than yourself or your personal representative, please fill out the Authorization To Release Protected Health Information form. Once completed you can either email it to email@example.com or fax to 715-463-2753 to our Release of Information Specialist.
For release of radiology images only, please fax or email the completed Authorization To Release Protected Health Information form to the Radiology Department at 715-463-7347 or firstname.lastname@example.org. If you have questions, please contact Radiology at 715-463-7292.
Upon receipt, we will process your medical record request and send as indicated in the authorization form. This may take up to seven business days. A member of our Grantsburg, WI urgent care clinic team will contact you if extra time is needed to process your request. Please bring a photo ID if you choose to pick up the medical records in person.
If you are requesting electronic or paper copies for personal use, there will be a fee in accordance with the Wisconsin fee schedule. For detailed information please contact the Release of Information Specialist at our urgent care clinic in Grantsburg, WI at 715-463-7240 or email@example.com.