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American Family Children's Hospital
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Obtaining Medical Records

Questions

Please call Health Information Management at (608) 263-6030, option 5, between 8am and 4:30pm, Monday through Friday

 

Walk-in Hours

8am-4:15pm, Monday through Friday, at 8501 Excelsior Drive, Madison

Map (pdf) 

You can request copies of your medical records from most UW Health sites (see exceptions in the section below) by:

 

Option 1

  1. Complete and print the UW Health Authorization for Disclosure of Protected Health Information Form (pdf).
  2. Mailing or faxing the completed form to the following address:

    CiOX Health
    8501 Excelsior Dr.
    Madison, WI 53717
    Fax: (608) 203-4580

Option 2

 

MyChart users can complete a Release of Information request by logging into MyChart, selecting Other Resources and then selecting Request My Medical Records.

 

Please note:The UW Health authorization does authorize release of records containing psychiatric diagnoses or treatment, alcohol or drug abuse information, or HIV or AIDS information, unless you specify any exceptions on the line above the signature line. Please be aware that other authorizations may handle these protected conditions differently.

 

Cost for Obtaining Medical Records

 

There is no charge for copies of your medical record requested from and sent  directly to other hospitals, clinics or physicians for further medical care. If the copies are needed for an upcoming doctor's appointment, the date of appointment should be documented on the request.

 

Due to the strict procedural and highly-regulated steps involved in the release of information process for requests directed by the patient, a fee is charged for this service:

 

Format of Original Patient Record Cost for Delivery in Electronic Format (CD/USB/download or portal) Cost for Record Delivered in Paper

Electronic or Hybrid (part electronic, part paper)

$6.50 flat fee for electronic portion, plus:

  • If applicable, $0.07 per page for CIOX Health's labor cost to create and deliver the portion of record maintained in paper
  • Plus sales tax, as applicable.

$0.07 per page for CIOX Health's labor cost to create and deliver the portion of record maintained in paper, plus:

  • Plus, if applicable, the lower cost under state-regulated patient rates or $0.90 for CIOX Health's average labor cost to create and deliver the portion of record maintained electronically
  • Plus $0.05 per page for supplies (paper and toner)
  • Plus actual postage, if mailed
  • Plus sales tax, as applicable

Paper

$0.07 per page for CIOX Health's labor cost to create and deliver the portion of record maintained in paper, plus:

  • Postage
  • Plus sales tax, as applicable

$0.07 per page for CIOX Health's labor cost to create and deliver the portion of record maintained in paper, plus:

  • $0.05 per page for supplies (paper and toner)
  • Plus actual postage, if mailed
  • Plus sales tax, as applicable

 

Requests from Persons Other Than the Patient

 

Wisconsin state statutes regulate the fees applied to requesters other than the patient. For actual costs, please contact Health Information Management. A quote will be sent to indicate the total cost for the copies that must be paid in full prior to records being released.

 

When will I receive my copies?

 

The average turnaround time is five business days. Copies of medical records will be released once payment is received. The following methods of payment will be accepted:

  1. Make payment online via credit or debit card at https://payportal.iodincorporated.com
  2. Mail payment to CIOX Health, ATTN: A/R Department, PO Box 19058 Green Bay, WI 54307-9058. Please make check or money order payable to CIOX Health.
  3. Make payment on-site at the UW Health CIOX Health at 8501 Excelsior Drive, Madison, WI, 53717. We accept credit or debit card, personal check or money order.
  4. Make payment via credit card by calling our Central Office at (866) 420-7455, ext. 512.