Form 2004 Authorization for Release of Records Form for Complaints Against a Health Care Professional - Wisconsin

Form 2004 Authorization for Release of Records Form for Complaints Against a Health Care Professional - Wisconsin

What Is Form 2004?

This is a legal form that was released by the Wisconsin Department of Safety and Professional Services - a government authority operating within Wisconsin. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the Form 2004 Authorization for Release of Records Form?
A: The Form 2004 Authorization for Release of Records Form is a document used in Wisconsin to request the release of medical records.

Q: Who can use the Form 2004 Authorization for Release of Records Form?
A: Any individual or entity that needs access to medical records in Wisconsin can use the Form 2004.

Q: Why would someone need to use the Form 2004 Authorization for Release of Records Form?
A: Someone may need to use the Form 2004 to obtain medical records for various purposes, such as filing a complaint against a healthcare professional.

Q: What information is required on the Form 2004 Authorization for Release of Records Form?
A: The Form 2004 requires information such as the patient's name, date of birth, the period covered by the records, and the purpose for which the records are being requested.

Q: Are there any fees involved in using the Form 2004 Authorization for Release of Records Form?
A: There may be fees associated with requesting medical records using the Form 2004. The fees can vary depending on the healthcare facility and the number of records being requested.

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Form Details:

  • Released on October 1, 2018;
  • The latest edition provided by the Wisconsin Department of Safety and Professional Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form 2004 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Safety and Professional Services.

Download Form 2004 Authorization for Release of Records Form for Complaints Against a Health Care Professional - Wisconsin

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