Obtaining copies of your medical records │ Permitting others to view or discuss your health information

Request copies of your medical records by downloading and completing this form. The form also can give your permission to share your medical records with another health care provider or system (you can make copies and send to them). You also will need to use the same form to allow Mayo Clinic Health System to discuss your billing or financial information with any other party.

Sign and return the completed form via one of these methods:

• Fax to 715-838-3058.
• Email Health Information Management Services.
• Mail it to the address listed on the form.
• Bring it with you to your next appointment (note that your records will not be available for pickup same day).

Complete the Authorization to Disclose Protected Health Information to Family and Friends form for adults or minors if you want to allow a family member or other individual access to your records to assist in your care.

Requesting changes (amendments) to your medical record

Request a change to your medical record. Follow the instructions on the form.

Adding information to your medical record

If you have documentation, such as a living will or health care power of attorney form or other information you wish added to your record, you may drop it off in person at Desk 2A in the La Crosse hospital building or mail the documents to:

Mayo Clinic Health System
Attn: HIMS
1400 Bellinger St.
Eau Claire, WI 54703-5211