How can I obtain a copy of my medical record?
You have the right to view and/or request copies of your health care record. To view your health care record, you must make an appointment with the Release of Information Department at the Bellin site your records are stored. (Photo identification is required.)
To obtain copies of your healthcare record, please download and complete the “Authorization for the Disclosure of Protected Health Information” and send directly to: Release of Information at the Bellin Site your records are kept that you are requesting.
Authorizations may also be faxed to (920) 433-7910.
Can I obtain medical records on someone other than myself?
If you are requesting records on someone other than yourself, you will need to provide legal documentation verifying legal guardianship, power of attorney, personal representative, etc. Biological parents may request copies of their minor child’s records as long as their parental rights have not been terminated.
Note: For billing information, please contact Patient Business Services at (920) 445-7210.
How long does it take to obtain copies of my medical records?
It takes approximately 3-5 days to complete a request once it has been received. We realize there are circumstances when your medical record will require immediate disclosure. If this is your situation, please call Release of Information to discuss your needs.
Is there a cost to obtain a copy of my medical record?
There is no charge for copies of your medical record if it is mailed directly to another physician or healthcare facility. Records requested for any other reason may be subject to a processing fee. Please contact Release of Information for more information.
Who can pick up my medical records?
If someone other than the patient will be picking up copies of medical records, that person must bring written authorization from the patient. Photo identification is also required when picking up medical records.
What if I find an error in my medical record?
If you believe that information within your medical record is incorrect or incomplete, you may request to have that information corrected. If we determine to the best of our knowledge your information is accurate and complete, or if Bellin Health did not create the information, we may deny your request. However, if we deny any part of your request, we will provide you with a written explanation of our reasons for doing so. Requests to make a correction to your records must be in writing and ask that you complete the “Request to Amend Protected Health Information” form.