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Patient/Guest InfoMedical Records
Obtaining Copies of Your Medical Records
St. Vincent Hospital maintains a file of your treatment records. We will forward copies of your medical records directly to other health care providers at no cost upon request from either you or that provider when needed for your continued care. However, you may wish to obtain copies of your records to keep for yourself or to take along to appointments with new physicians. Wisconsin State laws, as well as Federal Privacy Regulations, give you have a right to obtain a copy of your medical records.

Authorization Forms:
St. Vincent Hospital requires patients to request access to records in writing. A “Patient Request to Access Health Information form is available for printing from this page, or can be requested by calling us at (920) 433-8413. It must be filled out completely and sent to us at the address below. 
If you want your information released to another party who is not providing continuing care for you, an authorization form must be completed and signed. You can obtain a form by calling us at: (920) 433-8413 and we will mail it to you. The form should be filled out completely, signed and dated by the patient or the person legally authorized by the patient* and be sent to the Health Information Management Department at the following address:

St. Vincent Hospital

Health Information Management Department

Attention: Release of Information

P.O. Box 13508

Green Bay, WI 54307-3508
FAX: (920) 431-3071

Click here
to down load PDF file. In addition to the form, please include a copy of your photo identification card or driver license.

Fees (Patient Requests): There is a cost associated with retrieving, copying and documenting release of medical records. Because we support your right to obtain your medical records, St. Vincent Hospital will provide the first 10 pages of copies free of charge to patients. If records requested exceed 10 pages, you will be charged 30 cents per copied page, plus postage costs. You may request an estimate prior to copying if you are concerned about the cost.

Types of records: Hospital records can be quite lengthy. The most pertinent parts of the record of interest to you or your physician are: history and physical (H&P), operative report, consultations, discharge summaries, diagnostic test results (x-ray, lab, EKG, etc.) The Health Information Management staff can help you determine what portion of your record is most pertinent for your needs in an effort to keep your costs to a minimum.

If you have any questions about obtaining your records, contact the Health Information Management Department at (920) 433-8413.

Persons legally authorized to sign for the patient:

Legal Guardians, Parent, guardian or legal custodian of a minor patient; legal guardian of a patient adjudged incompetent by the court (a copy of the guardianship letter is required); the spouse or personal representative of a deceased patient - If no spouse survives a deceased patient, an adult member of the deceased patient’s immediate family; a health care agent designated under Chapter 155 if the patient is deemed incapacitated (both the Power of Attorney for Health Care document as well as verification of incapacity are required); a temporary guardian appointed by a court to authorize release of records (a copy of the appointment papers are required).

Hospital Sisters of the Third Order Regular of St. Francis Hospital Sisters Health System