To request a copy of your medical records from our medical records department, download and complete the Medical Release Form. Contact Prevea Record Release at (920) 496-4783 for more information. Please fill out a release authorization form prior to treatment.

Requesting your medical records

1. Click the link below to download an Authorization for the Release of Medical Information
   • Medical release form - English
   • Medical release form - Hmong
   • Medical release form - Somali
   • Medical release form - Spanish

1. Complete all fields of the authorization form
2. Fax (920) 496-4737 or mail to Prevea Health Services Attn: Records Release, P.O. Box 19070 Green Bay, WI 54307. 

Typical processing time to request medical records is 7-14 business days.​

To request radiology images

For radiology records, please fax the above form to (920) 272-1529 or call (920) 272-3316.

​Typical processing time to request medical records is 7-14 business days.​

Transferring your care to Prevea?

Follow these steps when requesting records from other facilities:

1. Obtain an authorization form from the facility you currently obtain care
2. Complete all fields of the authorization form
3. Return the form back to the facility for processing

OR

We can help! Complete our authorization and provide us your doctor’s name and we will work with your health care facility to obtain your records.

View your health records from your computer or mobile device with MyPrevea. A free, online personal health record that you can securely access from your home computer, laptop, mobile device or smart phone.  Learn more!