Patients & Visitors
- Advance Care Planning
- DAISY Award
- Food and Meal Service
- Gift Shop & Store
- Health Insurance Marketplace
- Language Assistance
- Information for New Patients
- Organ Donation
- Parking and Directions
- Patient Representative
- Patient Safety
- Quality Reporting
- Records and Registration
- Rights & Responsibilities
- Social Services
- Spiritual Care
- Tobacco Free Campus
- Visiting Hours
- Weapons Ban
Records and Registration
If you are a new patient at Mayo Clinic Health System – Franciscan Healthcare, you will need to provide the following information upon registration:
- First, middle and last names (as listed on your birth certificate)
- Date of birth
- Social Security Number (optional)
- Complete address (including apartment, lot or trailer number)
- Home telephone number
- Martial status
- Maiden or previous name
- Employer name, address and telephone number
- Emergency contact name and number
- Insurance information
All patients should arrive approximately 20 minutes prior to their appointment to allow time to complete the necessary forms. If you need to cancel an appointment, please call at least 24 hours in advance.
See our New Patients web section for additional information on being a new patient at Mayo Clinic Health System - Franciscan Healthcare.
Obtaining copies of your medical records
Permitting others to view or discuss your health information
Download and complete this form to request copies of your medical records or to provide us with your permission to share your medical records with another health care provider or system (make copies and send to them) or with another individual -- such as a family member -- who you wish to assist with your care. You will also need to use the same form to allow Franciscan Healthcare to discuss your billing/financial information with any other party.
Return the completed form to one of the following
- Health Information Management Services (Operations office) - FAX: 608-392-9897
- Health Information Management Services (Release of Information/Records) - FAX: 608-392-9799
- or email Health Information Management Services
A central point where patients (or their designees) may view copies of their medical records is on the second floor of the La Crosse Hospital building, near Desk 2A above the hospital main entrance. Both clinic and hospital records are available for viewing at this location. Patients (or their designees) can also sign authorization forms, pick up copies of their records and have other questions about records management answered. The office is staffed from 8 a.m. to 4:30 p.m. Monday through Friday and the telephone number is 608-392-6275.
Requesting changes (amendments) to your medical record
Follow the instructions on this form to request a change to your medical record. The instructions tell you how to request changes and where to return the information.
Adding information to your medical record
If you have documentation such as a living will or health care power of attorney form or other information you wish added to your record, you may drop it off in person at Desk 2A in the La Crosse Hospital building or mail the documents to:
Health Information Department
Fourth Floor - St. Ann Building
Mayo Clinic Health System - Franciscan Healthcare
700 West Avenue South
La Crosse, WI 54601
Additional Information and Consent Forms for Health Tradition Health Plan Members:
Authorization for Disclosure of Information - This form allows you appoint a representative who can act on your behalf to inquire about claims or referrals, resolve issues for you, make changes to your account or file a complaint on your behalf. You must indicate the information that can be discussed with the representative as well as those that cannot. You can limit the types of information and the time frames for the authorization.
Regulations stipulated by the Health Insurance Portability and Accountability Act (HIPAA) and Wisconsin State Law require that authorizations be in place for adults to inquire on their child’s account based on the ages and subjects below:
Medical, Claims and Referral Information
Any adult over eighteen (18) years of age must give authorization. Parents of children younger than 18 years do not need authorization. Please note that college students must authorize their parents to act for them. Special rules apply to mental health or family planning related information.
- Mental Health Services - Any member over fourteen (14) years of age must give authorization. In order for the parent or legal guardian to inquire about any information or service related to the child, the child must sign an Authorization to Release Information form.
- Family Planning Services - Any member over fourteen (14) years of age must give authorization. In order for the parent or legal guardian to inquire about any information or service related to the child, the child must sign an Authorization For Disclosure of Information form.
Members are required to fill out these two forms if he/she chooses to appoint a representative to act on their behalf in the Health Tradition’s Appeals and Grievance process.
- Authorization for Representative to Act on My Behalf in Appeals and Grievances
- Authorization for Release of Medical Information for Use in Appeals and Grievances
Revocation of Authorization for Disclosure of Information - You have the right to revoke an Authorization at any time. To revoke a previously submitted authorization, fill out the revocation form and return it to Health Tradition.
Please visit the Health Tradition Health Plan web for additional information.