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Patient Forms


 

If you are a new patient to BayCare Clinic, below are some forms to assist in expediting your registration process.

 

Knowing your past and present health information is an important part of your overall exam. Completing the appropriate forms below, prior to your visit, allows you the time to assure all medical conditions and medications are communicated and will save you time at registration.


Current medication list
Injury questionnaire
Authorization to verbally disclose protected health information


Additionally, some of our specialties have patient forms specific to their area of care. Please see the “our specialties” tab for access to our specialty departments and their patient forms.

 

MEDICAL RECORDS REQUEST


Release of information and authorization to disclose - written records

Revocation of informed consent for release of patient health information

If you need a release of medical records from a BayCare Clinic provider, please use the above form. Once this form is completed, please send it to:

BayCare Health Systems
164 N. Broadway
Green Bay, WI 54303

Or fax to: 920-544-5586

There is a per page fee associated with the release of medical records. You will be contacted by BayCare Clinic regarding the charges that will be incurred before the records are released. If you have any questions, please call 920-544-5414. 



ADVANCED CARE PLANNING

 
Advanced Care Planning is:

 

  • Preparing for how your health care treatment options will be addressed when you are unable to speak for yourself;
  • Communicating with family/friends your preference for care;
  • Documenting your wishes via Advanced Directives (documents that speak for you) such as a Living Will or a Power of Attorney for Health Care. A Living Will states what you want, but does not give anyone authority to make decisions on your behalf. The Power of Attorney for Health Care is a document in which you appoint an agent to make decisions regarding your care when you cannot make your own decisions.

If you do not have a living will or medical power of attorney, and are interested in completing an advanced directive packet, the link below will provide the information and documentation that you will need: Advanced Directive Information

 

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164 N. Broadway Green Bay, WI 54303