Take care of you and your family with My Marshfield Clinic. Your accountallows you to make appointments, request medication refills and communicate with your care team. Or, view your care history – accessmedical records, health reminders and billing statements. Sign in or register for My Marshfield Clinic Contact theMarshfield Clinic Helpline at: 877-349-9449. Access to great health care shouldn't be complicated. The My Marshfield Clinic app makes it easy to schedule appointments, view health records, message your provider and much more. Download the app today 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 Financial Assistance Policy (English) 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 
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Release of Information Request - Patient Access
Spanish: Solicitud Para Divulgar Información – Acceso del Paciente
Hmong: Daim Ntawv Thov Muab Ntaub Ntawv Qhia Tawm – Tus Neeg Mob Saib Tau
Release of Information Authorization
Spanish: Descargo de Autorización de Información
Hmong: Tsab Ntawv Tso Cai Qhia Tawm Cov Ntaub Ntawv
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
Hmong: Daim Ntawv Thov Muab Ntaub Ntawv Qhia Tawm – Sau Cia/Qhia Tseg Txug Kev Mob Nkeeg
Release of Information Request - Restrictions by Patient
Spanish: Solicitud de Divulgación de Información – Restricciones Por Paciente
Hmong: Kev Thov Qhia Tawm Cov Ntaub Ntawv Kho Mob – Lus Txwv Los Ntawm Tus Neeg Mob
Release of Information Request - Accounting of Disclosures
Spanish: Solicitud de Divulgación de Información – Registro de Divulgaciones
Hmong: Daim Ntawv Thov Qhia Tawm – Daim Ntawv Teev Cov Kev Qhia Tawm
Release of Information Revocation Notice
Spanish: Aviso de Revocación de la Divulgación de Información
Hmong: Daim Ntawv Qhia Kom Rho Tawm Kev Qhia Tawm Cov Ntaub Ntawv
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
Hmong: Rho Tawm Txoj Kev Tso Cai – Kev Kho Me Nyuam Yaus/Tus Laus Hauv Chaw Tiv Thaiv Thaum Tsis Muaj Niam Txiv/Tus Neeg Saib Xyuas Nyob Rau Ntawd
Financial Assistance Application Checklist
Spanish: Lista de Verificación Aplicación Para Solicitud de Asistencia Financiera
Hmong: Daim Ntawv Sau Qhia Thov Nyiaj Pab
Patient Financial Services
Patient Assistance Center
Insurance Eligibility Helpline
