Request a Copy of Health Records to be Sent to Other Third Party

The Health Information Management Department of Door County Medical Center is happy to assist patients in arranging for a copy of their health records to be sent to insurance companies, Workers Compensation carriers, disability agencies, attorneys, etc.  Federal and state law requires a more detailed authorization for this type of disclosure.

To request a copy of your health information/records to be sent to a third party,  please download,  print,  and complete the form at the bottom of this page and mail, fax or email it to:

Health Information Management Department
Door County Medical Center
323 South 18th Avenue
Sturgeon Bay, WI  54235

Fax:  920.746.3694
Email:   DCMC_HIMRESPONSE@dcmedical.org
 
There may be a charge for these copies.

DCMC-Main-Autho-Form

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