United States Department of Veterans Affairs

William S. Middleton Memorial Veterans Hospital

Release of Information

Our Release of Information staff will be happy to assist you with requests for your medical records. We also assist providers with completing forms for patients.

We can assist you with the following —

  • access to your medical records
  • obtaining copies of your medical records
  • requests to amend your medical records
  • completion of forms for benefits, insurance, and other reasons

The Release of Information Staff is expert in our patients' rights and their medical records.

The Release of Information Office is located on the Ground floor, room A28.

How to Request Information

If you need to get information from your medical records, please contact out Release of Information Office at (608) 256-1901, extension 14430.  Form 10-5345a (can be found listed in the column to the right) can be faxed to (608) 830-6655.

Or, you can print one of the forms listed in the column to the right, complete the requested information, sign the form, and mail it to the following address —

William S. Middleton Memorial Veterans Hospital
Release of Information
2500 Overlook Terrace
Madison, WI 53705

Because forms must contain an original signature, e-mailed forms cannot be accepted.

Requests for records will take approximately 20 business days to process.

Fees

There is no cost to send copies directly to another health care provider. If copies are for a patient's personal use, photocopying fees may be assessed.


Patient Information

Patient Information
Eligibility
Make, Change, or Cancel an Appointment 
Advance Directives 
Patient Education
Patient Services
Customer Service 
Discharge
Billing and Insurance 
Release of Information 

Release of Information Forms

pdf document Request for and Authorization to Release Medical Records or Health Information (VA 10-5345) 
pdf document Individuals' Request for a Copy of Their Own Health Information (VA 10-5345a) 

Related Links

Notice of Privacy Practices