Medical Records Information and Authorization for Release of Medical Information

Q: How can I get a copy of my medical records released to a third party?
A: The appropriate form is available below. You will need to sign this form before we can release your medical records.

Q: Will I be charged for a copy of my medical records?
A: Meriter contracts with a third party company. The charges are as listed below.

$1/page for pages 1-25
$0.75/page for pages 26-50
$0.50/page for pages 51-100
$0.30/page for 101+
Microfilm pages: $1.50/page

Plus Shipping and Handling

Q: If I wish to share my protected health information at Meriter with another party, will I need to fill out a form?
A: Yes, the form that's below should be used if you wish to share records. The form should also be used if you wish to share records with someone for whom you have legal authority (parent of minor, etc.). 

Download an Authorization/Consent for Release of Medical Information from Meriter Hospital and Clinics Form and the Fee Acknowledgement Form

Helpful Tips When Filling Out Meriter's Authorization Form

• In number 2 on the authorization form, you will put "Meriter Hospital". You are authorizing Meriter Hospital to release your records.
• In number 3 on the authorization form, you will put where you want your records to go to.

Please make sure all information is legible and that everything on the form is complete. This will eliminate any delay in your request.

Q: How long does it take to process my request?
A: It usually takes 7-10 business days to process your request.

Q: Can a family member or friend sign a consent form for a copy of my medical records?
A: No one except for the person whose name appears on the medical record can sign the consent form. However, if the medical records are for a minor or an adult under the care of a legal guardian, the legal guardian may sign the consent form.  If you are the legal guardian, we will need a copy of the guardianship papers along with the authorization form. If you are the POA, we will need a copy of the POA and activation form (certificate of incapacity statement) along with the authorization form. This will allow us to process your request in a timely manner.
   
Q: How can I receive my medical records?
A: We can mail your medical records to you, or you may pick them up in the Meriter Department of Health Information Management (2650 Novation Parkway). Medical records cannot be faxed due to lack of confidentiality.

Q: If I had a procedure done at another hospital, is that information in my medical records at Meriter?
A: Meriter only has medical records for procedures done at Meriter Hospital. To inquire about medical records on procedures done at other hospitals, you must contact each individual institution.

Q: What if I do not agree with comments made by a physician on my medical records?
A: You have the right to make an addendum to your medical record. Contact the Meriter Department of Health Information Management at (608) 417-6402.

Q: Can I get a copy of my birth certificate from the Meriter Department of Health Information Management?
A: Birth certificates are not kept in your medical record, even if you were born at Meriter. You will need to contact the State of Wisconsin Department of Vital Records at (608) 266-4142 for information on how to receive your birth certificate. Note that the Wisconsin Vital Records Web site also has forms you can print out to request your birth certificate.

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