Medical Records Request
As a patient, you have the right to access your medical records. Here you'll find instructions and a convenient form to help us process your request.
Under Federal and State law, a patient has a right to request a copy of his or her medical records.
If you need a copy of your medical records, please call the Ascension Sacred Heart Medical Records Office at the appropriate hospital listed below or complete this form (Medical Records Request Form for Ascension Sacred Heart) to get more information about accessing your records.
To help us process your request, please have the following information ready when you make your call.
1. Patient Information
Please provide all identifying information to help us make sure we have the correct patient. If you have been seen under another name in the past, it is important that you tell us that so we can copy all available information. Additionally, it is important that we know how to contact you should we have questions.
2. Authorizes Disclosure By
Identify the organization to which you are making the request for copies. For example: Saint Michael's Hospital, Stevens Point, Wisconsin. Please note you can use this same form to request a non-Ascension healthcare provider to send records to an Ascension provider/facility.
3. Disclosure of Health Information To
Tell us who should receive the copies. Identify the individual, physician, clinic, or hospital. If the request is for personal use, indicate "self." We must have a complete and accurate name (physician or clinic) and address to be able to process the request. If you are authorizing copies from another facility to be sent to another Ascension provider/facility, please indicate which Ascension organization.
4. Information to be Disclosed
Please help us identify exactly what types of reports you want copied. There are many different forms in a medical record and if we can target specifically what you want, we can avoid unnecessary copies.