Request Medical / Consumer Records

An Authorization for Disclosure form is required when you request copies of your medical/consumer records be sent to another healthcare provider or third party.

View the Authorization for Disclosure form in English (PDF)

View the Authorization for Disclosure form in Spanish (PDF)

Mail, fax, email, or hand-deliver form to:
Walworth County Department of Health and Human Services
1910 County Road NN
P.O. Box 1005
Elkhorn, WI 53121
Phone: 262-741-3200, Fax: 262-741-3217
Email Health and Human Services

For assistance obtaining records, call 262-741-3200 between 8 a.m. and 4:30 p.m. and ask for Medical Records.

Notice of Privacy Practices

Review the Walworth County Health and Human Services’ Notice of Privacy Practices (PDF) or Notificacion de Practicas de Privacidad (PDF).