Please download and print these commonly requested forms.
Some are even available to fill out online. We’re also happy to send forms by email or the US Postal Service.
- If you need additional assistance, please contact Member Services at (608) 828-4853 or (800) 605-4327.
- Please note that now our Release of Information vendor CIOX, requires payment for medical records. If you have questions, please call CIOX Health toll-free at (800) 367-1500.
Release of Information Forms
Health Care Forms
Ages and Stages Child Check-Up Questionnaire Forms
Health Insurance Forms
Electronic Health Information (EHI) Export
The 21st Century Cures Act Final Rule requires providers to export all EHI that is stored for a single patient whose EHI is in the system (EPIC) upon request by the patient. The export is a machine-readable format file and contains all health information that a patient already has the right to access through the release of information process. This file is easily understood and processed by computers, not humans and would require outside tools and software to interpret.