You're considering making an investment in your health and well being, and it’s not unexpected that you might have questions.

Please call 800-767-4411 if you have questions that are not answered here.

Who is authorized to sign for release of my health information?

The following people are authorized to sign for release of written information:

• The patient
• Legal Power of Attorney (if the patient is unable to sign; legal document must be provided)
• Parent (if the patient is younger than age 14)
• Legal Guardian (if the patient is younger than age 14; proof of guardianship must be provided)

What if the patient is deceased?

Records of deceased patients may only be released by authorization of the surviving spouse. If no spouse is living, a court-appointed representative or executor of the estate may authorize the release. If neither of these exists, an adult member of the family may consent. A copy of the death certificate for the patient, as well as the spouse if deceased, is required.

How much does it cost to obtain a copy of my health information?

There is no charge for releasing copies of health information directly to your other health care providers. There is a processing/copying fee for requests made by the patient/family for personal use. After the Health Information Department receives the completed authorization form and verifies the validity of the request, these costs will be calculated and you will be notified of the total fee due. Pre-payment of this fee is required before the information is sent.

How do I request a copy of my health information records for my hospitalization after discharge?

If you didn’t complete the authorization during your stay, you can request a copy of your written information in your patient record by printing out and completing an Authorization for Use & Disclosure of Health Information form.

Mail the completed form to: Health Information Department, Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI 53066.