PATIENT REQUEST FOR LABORATORY RECORD

Wyoming Public Health Laboratory follows all HIPPA guidelines.  If a patient would like access to their laboratory record, or disclosure of their laboratory record to another person or entity, these are the forms to use.  The forms are pdf format, but they are not "fillable", they must be printed and then completed.

 

Use this form when a patient would like a copy of their laboratory record: 

 Request for Access to Records

 

Use this form when a patient would like a copy of their laboratory record released to another person or entity:

 Use or Disclosure Authorization

 

 

These forms are for patient requests directly to the WPHL only.  Healthcare providers use the "Healthcare Provider Request for Faxed Test Result" found on the Forms page.