​Transfer Your Medical Records

For continuity of care, you may choose to transfer your medical records from your previous health care professional to your new GHC-SCW provider.

Steps to Follow to Transfer Your Medical Records

  • Download and complete the Authorization to Electronically Disclose Health Information to obtain medical information from UW Health and Meriter only. 
  • 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).
  • Review the expiration date of the authorization. If you would like a different expiration date, please indicate it.
  • Review your rights for this authorization.
  • Obtain the member or legal representative’s signature, relationship to member and date.
  • If this request relates to AIDS/HIV, mental health care, alcohol/drug use or developmental disabilities, please sign and date under the specified section.

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.

To obtain an Authorization to Release Medical Records form by mail or email, please contact Member Services.

Contact Member Services

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.