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:
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.
Request a change to your medical record. Follow the instructions on the form.
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
1400 Bellinger St.
Eau Claire, WI 54703-5211
If you have any questions, please call Health Information Management Services Release of Information at 507-284-4594.