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