Manage health care on your time. My Marshfield Clinic is your go-to place for organizing health care available via our website or through the mobile app. For most patients, sign-up only takes minutes. Sign in Create an account Contact theMarshfield Clinic Helpline at: 877-349-9449. Make a payment now Common billing questions Find information regardingyourbills, insurance and account changes. Frequently asked questions aboutprovider-basedbilling Health care services provided in the medical officesat certain Marshfield Clinic Health System locations will be considered hospital outpatientservices and provider-based. This means these services will be billed as hospital outpatient care. Learn more about provider-based billing > Estimate the cost of your care (Fee Estimates) Patient Assistance Center Financial Assistance Accepted insurance plans Patient guide to insurance Common coverage questions Understanding payments and copayments The Health Insurance Marketplace Medicare patient information Spanish: Política de Ayuda Financiera Hmong: Daim ntawv thov nyiaj txoj cai Advance directive form (PDF) Advance directive appointment prep (PDF) Being a health care agent (PDF) Learn more about advance care planning and how Marshfield Clinic Health System can help: Viewadvance directive information > Wambi - Send a heartfelt thank you Shining Star – Special recognition with a gift Gratitude is a gift that benefits the giver and the receiver. Choose from three great options to recognize and celebrate exceptional care at Marshfield Clinic Health System. Share your gratitude now > Send us a message Make a payment, payment questions, ormodify apayment plan. Get help withonline bill pay. 1-888-258-9775Ext. 9-0700 Getcost-of-care estimates orinquire about financial assistance 1-800-782-8581Ext.9-4475 Update insurance information, insuranceand service coverage, plus eligibilityand referralassistance. 1-800-782-8581Ext. 7-5559 Health care how you want it
Get started with My Marshfield Clinic
Understand the costs of your next visit.
Make informed decisions about financing health care.
Apply for free or discounted rates at Marshfield Clinic. Consent Forms:
General Consent to Treatment
Spanish: Consentimiento – Tratamiento a Menores – Limitado (A Ser Utilizado Una Sola Vez)
Consent - Treatment of Minors - (One Time Use)
Spanish: Consentimiento – Tratamiento a Menores – Limitado (A Ser Utilizado Una Sola Vez)
Consent - Treatment of Adult Ward in Legal Guardian Absence
Spanish: Consentimiento – Tratamientos Para un Protegido Adulto en la Ausencia del Tutor Legal
Consent - Treatment of Minors in Parent/Legal Guardian Absence
Spanish: Consentimiento – Tratamiento de Menores en Ausencia del Padre/Tutor Legal
Consent Revocation - Treatment of Minor/Adult Ward in Parent/Legal Guardian Absence
Spanish: Revocación del Consentimiento – Tratamiento de Menores/Adultos Bajo Tutela en Ausencia del Padre/Tutor Legal
Voluntary COVID-19 Vaccination of Minors in Parent/Legal Guardian Absence
Release of Information Forms
Release of Information Authorization
Spanish: Descargo de Autorización de Información
Sharing of Information Authorization
Spanish: Autorización Para Compartir Información
Hmong: Daim Ntawv Tso Cai Saib Cov ntaub Ntawv
Release of Information Authorization Occupational Medicine
Release of Information Revocation Notice
Spanish: Aviso de Revocación de la Divulgación de Información
HIPAA-Related Forms
Accounting of Disclosures Request Form
Spanish: Solicitud de Divulgación de Información – Registro de Divulgaciones
Amendment/Correction of Health Information Request Form
Spanish: Solicitud de Divulgación de Información – Enmienda/Corrección de la Información de Salud
Restriction of Information Request Form
Spanish: Solicitud de Divulgación de Información – Restricciones Por Paciente
Miscellaneous Forms
Financial Assistance Application Checklist
Spanish: Lista de Verificación Aplicación Para Solicitud de Asistencia Financiera
Hmong: Daim Ntawv Sau Qhia Thov Nyiaj Pab
Marshfield Medical Center-Beaver Dam Chiropractic Clinic New Patient Registration Form
Patient Financial Services
Patient Assistance Center
Insurance Eligibility Helpline
Release of Information Authorization
Spanish: Descargo de Autorización de Información
Sharing of Information Authorization
Spanish: Autorización Para Compartir Información
Hmong: Daim Ntawv Tso Cai Saib Cov ntaub Ntawv
General Consent to Treatment
Consent - Treatment of Minors - Limited (One Time Use)
Spanish: Consentimiento – Tratamiento a Menores – Limitado (A Ser Utilizado Una Sola Vez)
Hmong:Tso Cai Kho Rau Cov Menyuam Uas Tsis Tau Muaj Hnub Nyoog (Siv Ib Zaug Xwb)
Consent - Treatment of Adult Ward in Legal Guardian Absence
Spanish: Consentimiento – Tratamientos Para un Protegido Adulto en la Ausencia del Tutor Legal
Hmong: Daim Ntawv Tso Cai – Kev Kho Ib Tug Neeg Laus Uas Tsis Txawj thaum Tsis Muaj Tus Neeg Saib Xyuas Nyob Rau Ntawd
Consent - Treatment of Minors in Parent/Legal Guardian Absence
Spanish: Consentimiento – Tratamiento de Menores en Ausencia del Padre/Tutor Legal
Hmong: Daim Ntawv Tso Cai – Kho Cov Menyuam Uas Tsis Tau Nto Hnub Nyoog Thaum Niam Txiv/Niam Qhuav Txiv Qhuav Uas Tau Kev Tso Cai Sawv Cev Raws Txoj Cai Tsis Nyob Rau Ntawd
Release of Information Request - Amendment/Correction of Health Information
Spanish: Solicitud de Divulgación de Información – Enmienda/Corrección de la Información de Salud
Release of Information Request - Restrictions by Patient
Spanish: Solicitud de Divulgación de Información – Restricciones Por Paciente
Release of Information Request - Accounting of Disclosures
Spanish: Solicitud de Divulgación de Información – Registro de Divulgaciones
Release of Information Revocation Notice
Spanish: Aviso de Revocación de la Divulgación de Información
Consent Revocation - Treatment of Minor/Adult Ward in Parent/Legal Guardian Absence
Spanish: Revocación del Consentimiento – Tratamiento de Menores/Adultos Bajo Tutela en Ausencia del Padre/Tutor Legal
Financial Assistance Application Checklist
Spanish: Lista de Verificación Aplicación Para Solicitud de Asistencia Financiera
Hmong: Daim Ntawv Sau Qhia Thov Nyiaj Pab
Voluntary COVID-19 Vaccination of Minors in Parent/Legal Guardian Absence
Marshfield Medical Center-Beaver Dam Chiropractic Clinic New Patient Registration Form
Release of Information Authorization Occupational Medicine
Patient Resources: Billing, Insurance, Medical Records (2024)
Table of Contents
Health care how you want it
Get started with My Marshfield Clinic
Consent Forms:
General Consent to Treatment
Spanish: Consentimiento – Tratamiento a Menores – Limitado (A Ser Utilizado Una Sola Vez)
Consent - Treatment of Minors - (One Time Use)
Spanish: Consentimiento – Tratamiento a Menores – Limitado (A Ser Utilizado Una Sola Vez)
Consent - Treatment of Adult Ward in Legal Guardian Absence
Spanish: Consentimiento – Tratamientos Para un Protegido Adulto en la Ausencia del Tutor Legal
Consent - Treatment of Minors in Parent/Legal Guardian Absence
Spanish: Consentimiento – Tratamiento de Menores en Ausencia del Padre/Tutor Legal
Consent Revocation - Treatment of Minor/Adult Ward in Parent/Legal Guardian Absence
Spanish: Revocación del Consentimiento – Tratamiento de Menores/Adultos Bajo Tutela en Ausencia del Padre/Tutor Legal
Voluntary COVID-19 Vaccination of Minors in Parent/Legal Guardian Absence
Release of Information Forms
Release of Information Authorization
Spanish: Descargo de Autorización de Información
Sharing of Information Authorization
Spanish: Autorización Para Compartir Información
Hmong: Daim Ntawv Tso Cai Saib Cov ntaub Ntawv
Release of Information Authorization Occupational Medicine
Release of Information Revocation Notice
Spanish: Aviso de Revocación de la Divulgación de Información
HIPAA-Related Forms
Accounting of Disclosures Request Form
Spanish: Solicitud de Divulgación de Información – Registro de Divulgaciones
Amendment/Correction of Health Information Request Form
Spanish: Solicitud de Divulgación de Información – Enmienda/Corrección de la Información de Salud
Restriction of Information Request Form
Spanish: Solicitud de Divulgación de Información – Restricciones Por Paciente
Miscellaneous Forms
Financial Assistance Application Checklist
Spanish: Lista de Verificación Aplicación Para Solicitud de Asistencia Financiera
Hmong: Daim Ntawv Sau Qhia Thov Nyiaj Pab
Marshfield Medical Center-Beaver Dam Chiropractic Clinic New Patient Registration Form
Patient Financial Services
Patient Assistance Center
Insurance Eligibility Helpline
Release of Information Authorization
Spanish: Descargo de Autorización de Información
Sharing of Information Authorization
Spanish: Autorización Para Compartir Información
Hmong: Daim Ntawv Tso Cai Saib Cov ntaub Ntawv
General Consent to Treatment
Consent - Treatment of Minors - Limited (One Time Use)
Spanish: Consentimiento – Tratamiento a Menores – Limitado (A Ser Utilizado Una Sola Vez)
Hmong:Tso Cai Kho Rau Cov Menyuam Uas Tsis Tau Muaj Hnub Nyoog (Siv Ib Zaug Xwb)
Consent - Treatment of Adult Ward in Legal Guardian Absence
Spanish: Consentimiento – Tratamientos Para un Protegido Adulto en la Ausencia del Tutor Legal
Hmong: Daim Ntawv Tso Cai – Kev Kho Ib Tug Neeg Laus Uas Tsis Txawj thaum Tsis Muaj Tus Neeg Saib Xyuas Nyob Rau Ntawd
Consent - Treatment of Minors in Parent/Legal Guardian Absence
Spanish: Consentimiento – Tratamiento de Menores en Ausencia del Padre/Tutor Legal
Hmong: Daim Ntawv Tso Cai – Kho Cov Menyuam Uas Tsis Tau Nto Hnub Nyoog Thaum Niam Txiv/Niam Qhuav Txiv Qhuav Uas Tau Kev Tso Cai Sawv Cev Raws Txoj Cai Tsis Nyob Rau Ntawd
Release of Information Request - Amendment/Correction of Health Information
Spanish: Solicitud de Divulgación de Información – Enmienda/Corrección de la Información de Salud
Release of Information Request - Restrictions by Patient
Spanish: Solicitud de Divulgación de Información – Restricciones Por Paciente
Release of Information Request - Accounting of Disclosures
Spanish: Solicitud de Divulgación de Información – Registro de Divulgaciones
Release of Information Revocation Notice
Spanish: Aviso de Revocación de la Divulgación de Información
Consent Revocation - Treatment of Minor/Adult Ward in Parent/Legal Guardian Absence
Spanish: Revocación del Consentimiento – Tratamiento de Menores/Adultos Bajo Tutela en Ausencia del Padre/Tutor Legal
Financial Assistance Application Checklist
Spanish: Lista de Verificación Aplicación Para Solicitud de Asistencia Financiera
Hmong: Daim Ntawv Sau Qhia Thov Nyiaj Pab
Voluntary COVID-19 Vaccination of Minors in Parent/Legal Guardian Absence
Marshfield Medical Center-Beaver Dam Chiropractic Clinic New Patient Registration Form
Release of Information Authorization Occupational Medicine
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