We will also be implement holiday hours on 1/18/21 in observance of Martin Luther King Jr. Day at all our GHC-SCW owned clinics which include:
Capitol Clinic Capitol-Regent Behavioral Health ClinicDeForest ClinicEast ClinicHatchery Hill ClinicMadison College Community ClinicPhysical Therapy at Princeton Club WestSauk Trails Clinic
Martin Luther King Jr. Day1/18/21
GHC-SCW Clinics and Administrative Offices
Closed
GHC-SCW Urgent Care Clinic at Hatchery Hill
Open 9 a.m. - 10 p.m.
Hatchery Hill Pharmacy 9 a.m. - 5 p.m.Other GHC-SCW Pharmacies
Group Health Cooperative of South Central Wisconsin (GHC-SCW) implementará un horario especial para El Día de Martin Luther King Jr. en las siguientes clínicas:
Capitol ClinicCapitol-Regent Behavioral Health ClinicDeForest ClinicEast ClinicHatchery Hill ClinicMadison College Community ClinicPhysical Therapy at Princeton Club WestSauk Trails Clinic
El Día de Martin Luther King Jr.
1/18/21
Las clínicas y oficinas administrativas de GHC-SCW estarán cerradas
La clinica GHC-SCW de Cuidado Urgente de Hatchery Hill Clinic estará abierta de 9 a.m. a 10 p.m.
La farmacia del Hatchery Hill estará abierta de 9 a.m. a 5 p.m.
Otras farmacias de GHC-SCW están cerradas
Please download and print these commonly requested forms. If you need additional assistance, please contact member services at (608) 828-4853 or (800) 605-4327. We’re happy to send forms by email or the US Postal Service.
Please note that as of Aug. 23, 2016, 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.
Authorization for Verbal Communication - EspañolAuthorization to Receive Medical Information From Another FacilityAuthorization to Receive Medical Information From Another Facility - EspañolAuthorization to Release Medical Information From GHC-SCWAuthorization to Release Medical Information From GHC-SCW - EspañolAuthorization to Release Payment InformationPower of Attorney for Health CarePower of Attorney for FinancesRestriction FormRevocation Form
Medical History Form (Pediatrics – English)Medical History Form (Adult – Español)Medical History Form (Pediatrics – Español)Consent for Non-Emergency Care & Treatment of Minors to Temporary Caregiver(s)Consent for Non-Emergency Care & Treatment of Minors to Temporary Caregiver(s) - EspañolFormulary Exception Request Form Prescription Drug Claim Form for Direct Member Reimbursement
GHC-SCW Member Appeal Form GHC-SCW Provider Appeal Form
(608) 828-4853 or (800) 605-4327, request Member ServicesMon. – Fri., 8 a.m. – 5 p.m.Email Member Services