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Medical Records

Medical Records

You may request a copy of your medical records at any time. An easy way to access your protected health information (PHI) is through MyChart. Log in—anytime, anywhere—to securely view your records, manage who sees your PHI or connect your account to other health systems. You may also request a copy of your medical records using the process below.

Log in to MyChart
Step 1: Download and print
For yourself
If you’re requesting records for yourself or as the legal representative on behalf of your child or another person, download the Patient Right of Access form.
Download Access Form
For a patient
If you’re a third part requesting patient records, such as an attorney or insurance company, download the Authorization for the Disclosure of Protected Health Information form.
Download Authorization Form
Step 2: Fill out form and return to us
Mail

Gundersen Health System
Medical Records
1900 South Avenue, AVS-001
La Crosse, WI 54601

Fax
Submit to (608) 775-4706
Step 3: Allow us time to process your request.
Processing can take 1-3 days
It takes about 1-3 days to complete your request once it has been received. We'll send your medical records to you in the format you've indicated on the authorization form (e.g., mail, secure email, MyChart). We realize there are circumstances when your medical record will require immediate disclosure. If this is your situation, please call us.
(608) 775-3199
Note
If you’re requesting records for someone other than yourself:
You must provide legal documentation verifying legal guardianship, power of attorney, personal representative, etc. Biological parents may request copies of their minor child's records, as long as their parental rights have not been terminated.
Get a copy of a birth certificate

To get a copy of a birth certificate, you must contact the County Register of Deeds in which the individual was born. Gundersen Health System does not have copies of birth certificates. More information is available at:

La Crosse County Register of Deeds | (608) 785-9644

Wisconsin Vital Records

Request a change to your medical records

If you believe information within your medical records is incorrect or incomplete, you may request to have that information corrected. Requests to make a correction to your records must be in writing.

Download and print the Request to Amend Protected Health Information form. Mail the completed form to:

Gundersen Health System
HIM Coordinator
1900 South Avenue, AVS-001
La Crosse, WI 54601

In certain cases, we may deny your request for a correction if the information:

  • was not created by us (if the person or entity that created the information is not available to make the amendment)
  • is not part of the health information kept for Gundersen Health System
  • is not part of the information you’re permitted to inspect and copy
  • is currently accurate and complete
Download amendment form
Restrict access to your health information

You have the right to restrict access to your protected health information (PHI). We will comply with your request unless the information is needed to provide emergency treatment, to comply with the law or otherwise specified on the request form.

To make a request, download and print the Request to Restrict Access to Protected Health Information form. Mail the completed form to:

Gundersen Health System
Privacy Office
1900 South Avenue, AVS-001
La Crosse, WI 54601

Download access form
Allow verbal communication of your health information

As a patient, you can authorize communication between Gundersen Health System providers and other individual(s) of your choice. This means Gundersen may leave a detailed message on the authorized person’s voicemail or speak to them regarding your treatment or bill.

To make a request, download and print the Authorization for Verbal Communication of Health Information form. Mail the completed form to:

Gundersen Health System
Patient Registration
1900 South Avenue, CB0-002
La Crosse, WI 54601

Need to cancel an authorization?

You may revoke (or cancel) an authorization, in writing, at any time. However, we’re unable to take back disclosures we have previously made with your authorization.

To revoke a previously signed authorization, print and complete the Revocation of Authorization form. Mail the completed form to:

Gundersen Health System
Privacy Office
1900 South Avenue, AVS-001
La Crosse, WI 54601

Download verbal communication form Download revocation form
Know with whom we've shared your health information

You have a right to request an "accounting of disclosures." This is a list of people with whom Gundersen may have shared your health information. This does not include information shared for purposes of treatment, payment or healthcare operations. It also excludes authorizations you have provided us.

We will provide the list at no cost once during each 12-month period. For additional requests, we may charge a fee. We'll notify you of the fee and you may choose to withdraw or modify your request at that time.

To request an accounting of disclosures, download and print the Accounting of Disclosures form. Mail the completed form to:

Gundersen Health System
Privacy Office
1900 South Avenue, AVS-001
La Crosse, WI 54601

Download disclosures form
Our commitment to you

Gundersen Health System respects each patient's right to confidentiality and privacy of healthcare information. We make every attempt to protect the privacy of patient information so it is not heard, read or shared with others for any reason other than to promote the best healthcare for our patients.

To disclose protected health information, we require signed authorization from the patient or legal guardian. The healthcare record is the property of Gundersen and is maintained for the use of the Hospital, Clinic, medical staff and for the benefit of the patient. You may request copies of your health information at any time.

Have questions about your medical record? We can help.

Our Information Security & Privacy department processes requests for medical records. If you have specific questions, we’re available Monday through Friday from 8 a.m. to 5 p.m.

Call (608) 775-3199

1900 South Ave.
La Crosse, WI 54601

(608) 782-7300

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