Request For Medical Records
How Do I Request a Copy of My Medical Record?
There are three options to request your medical records:
Patient Portal
Access your medical records online:
MyHealth Patient Portal is an online patient health-management tool provided by Beloit Health System. With MyHealth you can more effectively manage your health in one secure, convenient location. MyHealth will give you a new safe and private way to access your records 24/7. It's easy to use, free of charge and completely secure.
Already have a MyHealth Account?
Sign In
Need to Set-up your MyHealth Account?
Click Here
MyHealth Support
If you are experiencing trouble logging into your MyHealth account or experiencing other technical issues, please call 877.621.8014. Support staff is available 24 hours a day, seven days a week.
Electronically Request Records
You can now request to have your medical records sent securely to your email. Click on the button below to fill out the electronic request.
Request Records Electronically
Complete a Paper Request
To request a copy of your medical records at Beloit Health System or NorthPointe, complete an Authorization for Release of Patient Heath Information form, and submit it to the Health Information Management Department at the Beloit Memorial Hospital.
- Authorization for Release of Patient Heath Information Hospital Form
- Authorization for Release of Patient Health Information Hospital Spanish Form
- Counseling Care Center Informed Consent for Disclosure of Patient Health Care Information Form
- Counseling Care Center Informed Consent for Disclosure of Patient Health Care Information Form - Spanish
Submit in Person:
You may submit the request in person at Beloit Memorial Hospital from 8:00 am to 4:00 pm.
Mail To:
Beloit Health System
Health Information Management
1969 West Hart Road
Beloit, WI 53511-2230
Attn: Medical Records
Fax: 608-363-5798
If you have any questions, you can call the Health Information Department at 608-364-5128.
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