Understanding Your Medical Records
Most of your medical records are available through our secure patient portal, MyChart. If you prefer, you may request your records by completing and signing a release of information and submitting it through MyChart, by mail, by fax, or at one of our clinic locations.
Your record may include:
- Medications
- Allergies
- Diagnoses and health conditions
- Immunization history
- Treatment plans and care summaries
- Visit notes
- Lab results and radiology results
Your Privacy, Rights & Authorization
You have the right to request access to your protected health information. NorthLakes may share your information as allowed by law for treatment, payment, healthcare operations, or with your authorization.
The authorization form must include the patient’s or legal guardian’s signature and the date it was signed. For Substance Use Treatment patients 12 and older, both patient and parent/legal guardian must sign. For mental health counseling and psychiatry patients 14 and older, both patient and parent/legal guardian must sign.
Request Your Records
Download and complete the Authorization to Release Health Information form.
Submit Your Request
Online
Upload using MyChart.
Fax
Form to (715) 318-5644.
NorthLakes Community Clinic
c/o Medical Records
15954 Rivers Edge Drive
Hayward, WI 54843
In-person
Drop off at your clinic location.
Processing Time
We process requests as quickly as possible. Please allow up to 30 days for your medical records request to be completed.
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