Medical Records Request
Request Your Medical Records
For record requests, please complete and return our Release of Information (ROI) form. Please be sure to complete all sections of the form and return, along with a copy of your photo ID or any legal documentation required for this release request (if applicable). You can email it to: HIM@MiramontBH.com or fax it to our medical records office at 608-690-6891.
What happens after I submit my Medical Release Request?
Once received, records will be sent within 7 business days, in the format indicated on the release request. Please ensure to complete all sections of the request, including purpose for disclosure, format of release (electronic preferred), and date of expiration. Failure to complete release in its entirety could delay records.
Medical Records Email: HIM@MiramontBH.com
Medical Records Fax: (608)-690-6891
Medical Records Direct Line: (608)-716-8289
