Medical Records

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Medical Records Policy

The Fond du Lac County Department of Human Services (DHS) Medical Records Department maintains a health care record for all persons receiving treatment on the Acute Psychiatric Hospital Unit or through the Mental Health and Substance Use Disorder Outpatient service programs. The primary purposes of the health care record are:

1) To document the course of treatment and health care.

2) To provide a medium of communication among health care professionals for current and future care.

3) To substantiate treatment provided for third party payers in order to justify reimbursement.

The Fond du Lac County Department of Human Services respects our client's right to privacy by treating the health care record as confidential and, therefore, has developed policies and procedures to protect the client from any unauthorized release of confidential information. These policies and procedures are set within the current State and Federal Guidelines for inpatient and outpatient mental health and substance use disorder information along with facility specific guidelines.

How to obtain copies of your medical records

In order to obtain copies of your medical records, please visit the Medical Records department, Release of Information Coordinator. You will be asked to complete the Informed Consent to Release Confidential Information form. Or you may download the form, complete it and mail to:

Fond du Lac County DHS
Attn: Medical Records
459 E. 1st Street
Fond du Lac, WI 54935

Authorizations may also be faxed to (920) 929-3129.

Upon receipt of the Informed Consent to Release Confidential Information form, your request will be processed. You will receive a phone call informing you when your request is complete. Please note, it can take up to 30 business days to complete your request. If you need your request processed sooner, please contact us at (920) 929-3560.

Receiving your medical records

Your medical records may be mailed to you or picked up in the Medical Records department during regular business hours. Please specify your preference to receive your records. We will verify your current demographic information in order to send your records to you.

Copy Fees

There is no charge for the first request for a personal copy of your medical records, or if the request is made by another healthcare provider on your behalf. Should you make subsequent requests for a personal copy of your medical record, you may be charged according to Wis. Stat 146.83 (3f)(c)2.

Revocation of an authorization

You may revoke an authorization in writing, at any time. We are unable to retrieve any disclosures we may have already made with your authorization. If you wish to revoke an authorization, please contact the medical records department for assistance in completing the appropriate form. Your revocation will be in place immediately.

Amendments to your medical record

If you believe the information in your medical record is incorrect, you can request a change, or amendment, to your record. You must complete the Request to Amend Medical Record form. You may download the form and return it to the Medical Records Department to begin the process. Your request will be processed and reviewed by clinical staff and a determination will be made within 30 days.

Business Hours

Monday - Friday, 8:00am-4:30pm

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