Skip Ribbon Commands
Skip to main content
Sign In
Patients & Visitors Medical Record Request

Medical Record Request

​​​About Your Medical Records

SSM Health St. Mary's Hospital - Madison is committed to protecting your privacy and confidentiality. The Health Information Management Department maintains St. Mary's patient health care records. We also review all requests for copies before processing.

How to Obtain a Copy of a Birth Certificate

In order to obtain a copy of a birth certificate, and the individual was born in Wisconsin, you may request a copy from the State of Wisconsin Department of Health, Office of Vital Records. SSM Health St. Mary's does not have copies of birth certificates.

How to Obtain Copies of Medical Records

In order to obtain copies of your medical records, you are required to fill out an "Authorization for Use and Disclosure of Protected Health Information" form.

You may request one by calling the Health Information Management Department at 608-258-6689 or download the PDF below.

We require patient or legal guardian authorization in order to release copies of your medical records. These records are sent by mail and are not available by facsimile. The original records are kept at SSM Health St. Mary's. You may request copies of your records at any time. ​

Authorization for Use and Disclosure of Protected Health Information Form

Note: A separate authorization is required for each request.

Copy Fees

For current information about copy fees, please contact the Health Information Management Department at 608-258-6689. ​

Turnaround Time

Please expect a turnaround time of 10 - 14 business days for your request to be processed. For more information, please contact the Health Information Management Department at SSM Health St. Mary's at 608-258-6689.