Requesting Release of Your Confidential Records & Information

How to Request Records

An Authorization for Release & Exchange of Confidential Records & Information form is required when:

  • You are requesting copies of your confidential records
  • You are requesting copies of your confidential records and information be released to another health care provider for treatment.
  • You are requesting your confidential records and information be released to other third parties such as your lawyer, the Social Security Administration, your child's school system, etc.

Steps

  1. Print and fill out the Authorization For Release form found below. Instructions for this form are also provided. This form is not valid unless filled out completely and includes your written signature.
  2. Sign the form.
  3. Mail or drop off the form at:
Department of Human Services
OR  
Department of Human Services
PO Box 2187
211 N. Commercial St.
220 Washington Ave
Neenah, WI 54956
Oshkosh, WI 54903-2187

Authorization for Release of Information

Release Form Instructions

Pick Up

A photo ID will be required if you pick up you own records. If you name someone else to pick up your records, please make him or her aware they will need to show their own photo ID.

Fees

Please note that a fee is generally charged for record copies.