Health Records Information

As a patient, you have the right to get a copy of your medical record.  Please follow these simple steps to request a copy of your medical record free of charge.  

Step 1:  Complete an authorization in writing for Rogers to release your information.

Please print and complete the form for the state where you were treated.

California
Florida
Illinois
Minnesota
Pennsylvania
Tennessee
Wisconsin
Spanish form

Instructions for Completing Authorization to Release Protected Health Information
*Please note, due to state and federal laws, we are unable to process incomplete forms.

Step 2:  Submit your request to the Release of Information Team at Rogers.

• By mail:  

Rogers Behavioral Health
Health Information
34700 Valley Road
Oconomowoc WI 53066

• By fax:  262-646-5745

• By Email:  releaseofinformation@rogersbh.org

Your request will be completed within two weeks from the date it is received.

For questions, please call or email the Release of Information Team:
Phone:  800-767-4411, Option 3
Email:  releaseofinformation@rogersbh.org

HIPAA Notice of Provider Privacy Practices