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Request a Copy of Your Medical Records

We are happy to provide copies of your medical records upon request.

Print a Medical Record Request Form.

Complete an Online Medical Record Request Form.

To Obtain Copies of Your Medical Records

  1. The authorization to release your medical records must be completed, signed and dated by the patient or the patient's personal representative before copies can be provided. If a patient representative signs the authorization, a copy of the document conferring legal authority (power of attorney, court order, etc.) must be provided.
  2. Your request will take approximately five business days to be processed. Please allow additional days for mailing.
  3. If you are unable to pick up your medical records, please print the designated person's name on the authorization form so that their identification can be validated at the time of pick up.
  4. If requesting medical records for a deceased patient, please provide a copy of the death certificate and a complete Authorized Relative Certification form.
  5. If records are to be sent to your physician, please provide the name, address, phone number, fax number, and appointment date and time. We will forward copies of your medical records directly to your physician at no charge.
  6. A collection of your clinical documents and test results are provided free of charge for purposes of your medical treatment. There is no charge for the first set of radiologic images or pathology slides.
  7. If you wish to obtain copies of your medical record for your entire hospital stay, you will be charged a copy fee (see cost below) for the entire medical record chart. This includes requests to provide the medical records to another provider.
  8. Please refer to 735 ILCS 5/8-2006 for current fee schedule allowed for copying costs.
  9. If you are going to mail in your authorization, send it to the Health Information Management department, 12251 S. 80th Avenue, Palos Heights, IL 60463 or fax it to (708) 923-4688. If you fax your request, call to confirm that it was received. Requests received via email require the patient or designated representative to be present at pick up.

If you have any questions regarding your request, please call (708) 923-4664.

Valid ID must be shown when the records are picked up.
Download the Medical Record Release form from this website or call (708) 923-4688 to request a copy.

Medical Records Pick-up Hours

Medical Record pick-up is located in the lobby of the hospital. Go to the information desk and they will direct you.

Monday - Friday
7:30 a.m. - 4 p.m.

You have the right to request an amendment to your medical record if you believe the information is incomplete or inaccurate.

Print and complete Amendment Request Form.

Upcoming Events

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    Wednesday
    6:00 PM - 6:45 PM
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  • Sep
    29
    Thursday
    7:00 PM - 8:30 PM
    Get the information you need to make the best decision when it comes to your hip replacement.