Medical Release Forms
Click on the links below to download the medical forms (PDF) you may need.
The medical consent form is ideal for parents with children (under age 18) who will be out of town for a short period of time (day, weekend, etc.). It allows you to proactively consent to emergency/urgent medical care should your child become ill or injured in your absence.
The release of information form allows you to authorize KDH to release your personal medical records to another physician/provider, yourself, or to someone you designate. If you prefer to complete the release of information form in person, you may visit one of two Madison locations:
Downtown Medical Building (1st Floor - first window on left): 630 North Broadway.
Main Campus Medical Building (1st Floor -main lobby): 1373 East SR 62.
Contact Health Information Management (Medical Records) at 812.801.0520.
- Release of Information (English)
Once you complete and submit the form, a member of our Health Information Management team will process your request.
Printable Forms (PDFs)