To request your or your child’s medical records, you need to fill out the Patient Request for PHI form.  The form must include a parent or guardian’s written signature to be complete.

You can send the completed form in one of these ways:

• Fax: (414) 266-6316
• Email: Attach the form and send it to MedicalRecords@childrenswi.org
• Online: You can also request records through MyChart. Proxy and adult access forms are available on the MyChart page

If you’re a third party (such as an attorney or insurance company), you must send a completed and signed authorization form from the patient, parent or legal guardian.

This authorization form can also be used if a parent or legal guardian wants to:

• Give permission to talk about medical information with certain people
• Allow records to be shared with specific individuals for a set period of time

Children's Wisconsin Health Care Information Management Department:

(414) 266-2300