American Family Children's Hospital
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Requesting an Amendment to Your Medical Record

You can request an amendment of your medical record by:

  1. Completing and printing the UW Health Request of Amendment of the Medical Record(pdf) form. When completing the form, please make sure you provide all information in Section A.
  2. Mailing or faxing the completed form to the following address:

    UW Health Health Information Management
    Attention: Patient Amendments
    8501 Excelsior Dr. Room 116
    Madison, WI 53717
    Fax: (608) 203-1440

What is the cost for amending medical records?

There is no charge for requesting an amendment to your medical record.

When will I receive a response to my request?

Your request will be reviewed and approved or denied within 60 days of receipt of your amendment request. If the request involves a mental health diagnosis, it will be responded to within 30 days. If the request takes longer than the allotted time, an extension letter will be sent to you within appropriate time frame explaining the reason for the extension. 

What happens if my request is denied?

If your request is denied, you will receive a written explanation of the denial. If you disagree with the explanation, you can submit a one-page, written statement of disagreement or you can ask that your request for amendment and explanation of the denial be included in any future disclosure of the pertinent medical record information.

What if I don’t know the date of the document I want amended?

  1. You may schedule a viewing of your medical records with the UW Health Release of Information Department by calling (608) 263-6030, option 3.
  2. You may request a copy of your UW Health medical records by submitting an Authorization for the Release of Medical Information Request (pdf). Please note, there may be a charge for your records.
  3. You can request that any information contained in multiple locations within your medical record be amended per your request. Please note, additional information may be needed when specific dates are not indicated. 

How can I expedite the process?

Providing a copy of the document(s) in question, strike through the information you do not agree with, and writing in what you believe to be the correct information is very helpful and can expedite the process. Additionally, using one form for each requested amendment is helpful in expediting the process when you are requesting multiple amendments. 

What happens if my request is approved?

The approved form and the amended document(s) are sent to you via U.S. mail. 

What does "partially approved" mean?

The author of the document decided to amend part of your request, but not all. The provider will complete Section C of the amendment form indicating the reason for partial approval.

Why would my request be denied?

  1. UW Health did not create the information and you must return to the source to amend their document
  2. The information is complete and accurate as reviewed by the author.
  3. The author of the document is no longer employed by UW Health.
  4. The information is contained in psychotherapy notes.
  5. The information is compiled in anticipation of or for use in any civil, criminal or administrative action or proceeding.
  6. The information is not subject to disclosure to you under the Clinical Laboratory Improvements Amendments of 1988 (42 U.S.C. § 263a).
  7. You did not provide enough information to complete the request.
  8. The request is regarding billing information and needs to be redirected back to the billing department. 

What if the provider has left the organization?

If the author of the document has left the organization, the document can no longer be amended.  You are welcome to write a one-page statement of disagreement to be included in any future disclosures of the document.  

If denied, can I re-request the amendment?

Once the request has been denied, your option is to submit a statement of disagreement. 

How do I get my records permanently removed from UW Health?

The information contained within the UW Health record can not be permanently removed in its entirety. You can request that specific information is amended or removed, but the entire record cannot be removed.

What if I want the amended document released to others persons or parties?

To have your amended documentation sent to other parties, fill out an Authorization for the Release of Medical Information Request (pdf). 

You can also call (608) 263-6030, option 3.

 

Questions

 

Please call (608) 662-0821 between 8am and 4:30pm, Monday through Friday.

 

Walk-in Hours

 

8am-4pm, Monday through Friday, at 8501 Excelsior Drive, Madison