Health Information Management Release of Information
To protect our patients, families and health care workers during the global outbreak of COVID-19, this hospital has implemented vendor and visitor restrictions. With visiting restrictions in effect, UnityPoint Health wants to continue to make sure you have access to your medical records. For more information on how to obtain your medical records please follow these instructions. Thank you for understanding during this critical time.
Please print and complete the Authorization for Release of Medical Information form if you wish to share records and/or receive detailed voice messages related to your health information. The form should also be used if you wish to share records with someone for whom you have legal authority (parent of minor, etc.).
Helpful Tips | Completing the Authorization Form:
Frequently Asked Questions
In number 2 on the authorization form, you will put "Meriter Hospital or Meriter Clinics." You are authorizing Meriter to release your records.
In number 3 on the authorization form, you will put where you want your records sent.
Please make sure all information is complete and legible; this will eliminate delays in your request.
Authorization for Release of Medical Information
Q: Will I be charged for a copy of my medical records?
A: Yes, there is a charge to obtain a copy of your medical records. Meriter contracts with a third-party company, MRO, to perform our release of information services.
Q: How can I receive my medical records?
A: You have a few options to obtain a copy of your medical records;
You may visit MyUnityPoint, our secure patient website to access your health information. Information about registering for MyUnityPoint can be found by visiting chart.myunitypoint.org. If you need assistance using or enrolling for MyUnityPoint, please call the support team at 877-224-4430.
You may also request a copy of your medical record by contacting Meriter's Health Information Management department at (608) 417-6406. If you are a healthcare provider or records are needed today or our next business day, fax your request to (608) 417-6016 or email it to MSN_HIMROI@unitypoint.org. All other requests should be faxed to (877) 676-0484
Q. How can I transfer my medical information to Meriter?
A. There are two options for transferring your medical information to Meriter:
If you are transferring your care to a Meriter clinic, please contact your current provider to fill out an authorization form. After you fill out the form, please send it back to your current clinic and someone at that clinic will forward the form on to your new provider at Meriter.
If you are transferring your care to a Meriter clinic, you can fill out the Authorization/Consent for Release of Medical Information from Meriter Hospital and Clinics form that's above to request medical records from your current provider.
**For question number #2 on the form, please provide information about your current primary care physician and clinic.
**For question #3 on the form, please provide information about your new primary care physician at a UnityPoint Health – Meriter clinic.
Q: How long does it take to process my request?
A: Approximately 7-10 business days.
Q: Can a family member or friend sign a consent form for a copy of my medical records?
A: No one except for the person whose name appears on the medical record can sign the consent form. However, if the medical records are for a minor or an adult under the care of a legal guardian, the legal guardian may sign the consent form. If you are the legal guardian, we will need a copy of the guardianship papers along with the authorization form. If you are the Power Of Attorney (POA), we will need a copy of the POA and the activation form (certificate of incapacity statement) along with an authorization for Authorization for Release of Medical Information. This will allow us to process your request in a timely manner.
Q: If I had a procedure performed at another hospital, is that information in my medical records at Meriter?
A: Meriter only has medical records for procedures performed at Meriter hospital and clinics.
Q: What if I do not agree with comments made by a physician on my medical records?
A: You have the right to make an addendum to your medical record. If you would like to do so, please complete and mail the form that's below to the Meriter Department of Health Information Management. Contact the Meriter Department of Health Information Management at (608) 417-6406 if you have any questions.
Q: Can I get a copy of my birth certificate from Meriter?
A: You need to contact the State of Wisconsin Department of Vital Records at (608) 266-1371 for information on how to receive your birth certificate.