Patient Release of Information
If you would like us to release your medical information to another facility (insurance, other medical, legal, etc.), please fill out the Patient Authorization For Release of Information.
If you are a patient at Amery Hospital & Clinic, Clear Lake Clinic, Luck Clinic or Turtle Lake Clinic, please fax the form to our Medical Records department at (715) 268-0381.
Permission to Discuss Protected Health Information
We understand the importance of privacy when it comes to your health information – that's why we don't discuss your medical care with anyone that you haven't specifically authorized. If you'd like certain friend, family members or others to be involved in your care, please complete the Permission to Verbally Discuss Protected Health Information (PDF)
. This will let us know who you would like us to talk to regarding appointment information, lab and test results, treatment information and other medical information that you authorize.
Consent to treat patient - without parent/legal guardian present