Authorization for Exchange of Verbal and Written Information

You can authorize UW Health and/or your provider to participate in an exchange of both verbal and written information with another organization or person. To use this authorization, both verbal and written exchange of information must apply.

Note: If only authorizing verbal communication, please use the Authorization for Verbal Communication or Authorization for Release of Medical Information forms

• Complete and print the Authorization for Exchange of Verbal and Written Information form (pdf)
• Mail the completed form to the following address:
  
  UW Health
  Health Information Management
  Attention: Release of Information
  8501 Excelsior Dr., Room 101
  Madison, WI 53717
  
  
• Or fax the completed form to (608) 262-6663