​Transfer Your Medical Records

You may choose to transfer your medical records from your previous health care professional or a current health care specialist to your GHC-SCW provider.

Steps to Follow to Transfer Your Medical Records from another Healthcare Organization to GHC-SCW

  • Download and complete the Authorization to Receive Medical Records from Another Facility Form. The form authorizes your previous provider to release your medical records to GHC-SCW.
  • Complete the fields for member's name, social security number, daytime phone number and date of birth.
  • Complete the name and address of the person/facility of your previous health care provider from which the records should be released.
  • Check the appropriate information that is to be released (copied and/or faxed).
  • If this request relates to AIDS/HIV, mental health care, alcohol/drug use or developmental disabilities, please sign and date under the specified section.
  • Review your rights for this authorization here.
  • Review the expiration date of the authorization. If you would like a different expiration date, please indicate it.
  • Obtain the member or legal representative’s signature, relationship to member and date.

 

Mail the completed request to your previous health care facility. You will need to contact your previous clinic directly for information on where to mail or fax the completed form. Do not send your request form to GHC-SCW. Your previous clinic will process your request and send the medical information directly to GHC-SCW.

 

TRANSFER YOUR GHC-SCW MEDICAL RECORDS TO A THIRD PARTY

You may also choose to transfer your medical records from GHC-SCW to your new doctor, health care professional or a third party.

Steps to Follow to Transfer Your GHC-SCW Medical Records

  • Download and complete the Authorization to Release Protected Health Information from GHC-SCW.
  • Complete the fields for member's name, address, medical record/member number, date of birth, and daytime phone number.
  • Complete the fields for the name and address of the person/facility of your previous health care provider from which the records are to be released to. 
  • Check the appropriate information that is to be released (copied and/or faxed).
  • If this request relates to AIDS/HIV, mental health care, alcohol/drug use or developmental disabilities, please check the appropriate option(s) under the specified section.
  • Review your rights for this authorization here.
  • Review the expiration date of the authorization.  If you would like a different expiration date, please indicate it.
  • Obtain the member or legal representative's signature, relationship to member, and date.

You may email, mail, or fax your completed request to GHC-SCW's Health Information Management Department.  Your request will be processed by GHC-SCW's copy service, CIOX Health, and send directly to the party you identified as the recipient of your records. 

You may also request to have copies of your medical records sent to your active GHCMyChart account free of charge.  If you don't have an active GHCMyChart account, sign up here!

​Important: CIOX Health charges a copy fee if your request is not for the purpose of transferring your medical records to another healthcare provider.  To see CIOX Health's copy fee schedule, click here.

 

Contact GHC-SCW Health Information Management

Contact us at (608) 441-3500, option 1

Mon. – Fri., 8 a.m. – 4:30 p.m.

Contact CIOX Health (GHC-SCW's Copy Service)

Contact us at (608) 441-3500, option 2

Mon. – Fri., 8 a.m. – 12 p.m.

Contact Member Services

If you are unable to download and print any of the authorizations identified above, please contact Member Services and they will assist you.

Contact us at (608) 828-4853 or (800) 605-4327, and request Member Services.
Mon. – Fri., 8 a.m. – 5 p.m.
You can also Email Member Services with any questions you may have.