Instructions for Authorization for Form Completion
Instructions:
If you need a form/request processed by your Wheaton Franciscan Medical Group Physician please complete the authorization. Authorizations must be completed in full and signed by the patient, legal guardian or power of attorney. If the authorization is signed by the legal guardian or power of attorney it must be accompanied by the supporting legal documents unless a copy has already been placed in the patient’s medical record. Average processing time is approximately 7-10 business days which can be affected by the volume of requests and availability of the information.
You may return the authorization, your supporting documentation if applicable and your form/request as follows:
Wheaton Franciscan Healthcare-All Saints
Racine and Union Grove Patients Only
Drop off:
At any Medical Group Reception Desk
Mail:
Wheaton Franciscan Medical Group Attn: Provider Correspondence Unit
3807 Spring Street, Lower Level
Racine, WI. 53405
Fax:
Wheaton Franciscan Medical Group Attn: Provider Correspondence Unit
1 (262) 687-8179. If you are faxing your request do not enter your Social Security number on the authorization for security reasons.
Wheaton Franciscan Health-Franklin
Franklin Patients Only
Drop Off:
At your Physician’s Reception Desk
Mail:
Wheaton Franciscan Medical Group
Attn: (Your Physician’s Name)
10101 S. 27th Street
Franklin, WI. 53132
Fax:
Wheaton Franciscan Medical Group Attn:
Adult Internal Medicine - 1 (414) 325-4931
Family Medicine -1 (414) 325-4941
Pediatrics - 1 (414) 325-4921
Specialty Medicine - 1 (414) 325-4951
Woman’s Health OB/Gyn - 1 (414) 325-4911
Any questions regarding the above please call the Provider Correspondence Unit at
1 (262) 687-8408.