Patient Information

Do you need a copy of your medical records or other protected health information?

Download Authorization for Disclosure of Protected Health Information Form here.

Download Spanish Version of Authorization for Disclosure Form here. 

Patient & Family Services

Being admitted to the hospital can make some patients and their families worried. We have excellent staff to help you while you are in the hospital and when you leave the hospital. Medical social workers are available 24/7 to work with patients, family members, and medical staff to help patients get what they need, like:

Advance Directives

An advance directive is a legal document that tells your family, friends and other health care professionals your wishes about the medical care you want when you are too sick or hurt to do so. 

Our Patient and Family Services Department can help you complete your Advance Directive.

Download Advance Directive Document
Download Power of Attorney for Healthcare Document

Patient Rights & Responsibilities

Black River Memorial Hospital recognizes and respects patient rights. Patients become more informed and involved in their own care when they know their rights and responsibilities. Empowered patients ask questions and develop better relationships with their caregivers because they feel supported by the people directly involved in their care.

Download Patient Rights and Responsibilities

Your privacy is very important to us.

Download Privacy Statement. 

Cost Estimates

Do you want to know how much a procedure, test or exam might cost you before you make your decision? You can get an estimate by calling 715-284-1375 or 715-284-1368. We review price estimates between 8am and 4:30pm each day and we will respond within five business days.

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