OCD and Anxiety
Autism and Anxiety and Mood Disorders
Depression and other Mood Disorders
Trauma Recovery (PTSD)
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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.
Instructions for Completing Authorization to Release Protected Health Information
Spanish 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.
Rogers Behavioral Health
34700 Valley Road
Oconomowoc WI 53066
By fax: 262-646-5745
By Email: email@example.com
Your request will be completed within five to seven business days from the date it is received.
For questions, please call or email the Release of Information Team:
Phone: 800-767-4411, Option 3
HIPAA Notice of Privacy Practices
Revocation of Authorization to Release Information
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