Wisconsin Medical Records Release Form 2Wisconsin Medical Records Release Form 2Wisconsin Medical Records Release Form 2
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Medical Records Release Policy and Procedure
In response to the Health Insurance Portability and Accountability Act (HIPPA) of 1996, physicians have been faced
with greater complexities when releasing medical records. In an effort to protect patient confidentiality, as well as
comply with government regulations, Wisconsin Fertility Institute has developed policies and procedures to insure
that your confidential medical records are handled in a manner meeting all necessary guidelines.
Medical Records will be released only upon written request from the patient. Written requests must be in
accordance with the Uniform Health Care Information Act.
Wisconsin Fertility Institute will only release records that were created and maintained by our doctors and clinic.
We will not release records received from other clinics or providers.
The requirements for a valid authorization to release medical records are:

In writing, dated and signed by patient
Specifically identifies patient