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MyChart ® Epic Systems Corporation

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MyChart Forms

Access to another patient

To gain access to another patient's record, please fill out the form above and return it to your provider's office or send it to:
HSHS Eastern Wisconsin Division, Health Information Management Department
P.O. Box 13508
Green Bay, WI 54303

MyPrevea Forms

Access to another adult
Access to a child under 12
Access to a child between 12 and 17

MyChart Forms

Release of Medical Records