Medical Records

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.

Mail

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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