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Authorization for Treatment & Medical Records Disclosure

Streamlining Care for Workplace Injuries

Complete the form to authorize treatment, disclose medical records, and facilitate payment for workers’ compensation claims. Your health and recovery are our priority.

City of Racine Authorization for Treatment, Disclosure of Medical Records and Payment for Worker's Compensation Injury

(EMPLOYEE- Please provide a copy of this form to every medical provider you see.)

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About City of Racine Human Resources

Welcome to the City of Racine’s Human Resources department. Our passionate team is driven by the mission to empower our employees, enhance workplace diversity, equity, and inclusion, and recruit top talent to serve our vibrant community. Learn more about our values, objectives, and the services we provide in support of our city’s growth and development.

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