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. 

Black River Memorial Hospital participates in a health information exchange program through CommonWell Health Alliance. It's your patient right that your secure health data is available to you and your providers, regardless of where care is needed. Find out more information about this program.

Cost Estimates

Do you want to know how much a procedure, test or exam might cost you before you make your decision? Most people want to know the cost of their medical services, but don’t know how to access the information. Knowing the cost of a service up front helps you to make informed decisions about your health and care. In recent years, hospitals have introduced programs to provide easier payment methods for patients. One program is called Point-of-Service Payment, and it consists of patients paying their portion of the bill at the time of service.

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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