Essentia Health protects the confidentiality of your medical record. That’s why you are required to fill out and sign a form called the Authorization for Use and Disclosure of Protected Health Information. Once we receive a signed copy of this completed form, we can process your request.
To Release Your Medical Records
- Download and print the Release of Medical Information (PDF) form.
- Fill out the form. We need your hand-written signature to process your request.
- Send the form to:
PO Box 19058
Green Bay, WI 54307