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.