Medical Records Request

Mail Records or Request to:                                Call with Questions:                                               Fax Request or Records to:

Pauquette Center                    (608) 742-5518 opt. 5                (608)268-9780
Attn: Tanya Schulz
PO BOX 301
Portage, WI 53901

Use when requesting access to client's PHI as self or guardian.

BLANK - HIPAA Request for Access to Health Information

Use when wanting another entity to have access to client's PHI.

BLANK -Authorization to Use and_or Release Protected Health Information - Updated 5-3-2024