At Elmhurst Memorial Healthcare, we are sensitive to the private nature of a patient’s medical record. We take steps to assure that your medical records are kept confidential and secure.

Who is authorized to sign for the release of medical records?

A written authorization is required to release medical records. The following people are authorized to sign for release of medical records:

• The patient or the patient’s legally authorized representative (legal documents must be provided)
• The parent of a patient under the age of 18
• If the patient is deceased, legal documentation showing power of attorney for healthcare, executor of the estate or a death certificate showing next of kin is required

How to obtain medical records

To request a copy of your medical records, please complete the Authorization to Use or Disclose Protected Health Information and deliver in person, mail or fax to:

Medical Record Department
Elmhurst Memorial Hospital
200 Berteau Avenue
Elmhurst, IL 60126
Phone: 630-758-5280
Fax: 630-758-5072

You can either download the form from this Web site or call 630-758-5280 to request a form.

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Print/copy fees determined by the state of Illinois will be charged.

• A CD will be provided at 50 percent of the paper copy rate (48 hours notice is required).
• Payment (cash or check) will be required at the time of receipt of copies or before any copies are mailed to you.
• Medical records will be forwarded directly to another health care provider without charge.
• Please allow 5-7 business days for us to prepare your medical records and mail them.

Location and hours

The Medical Record Department is located on the first floor of the hospital. Enter through the main entrance and turn left. You will see the entrance to the department straight ahead of you.

We are open:
Monday through Friday 8 a.m. – 6 p.m.
Saturday 8 a.m.– Noon
Closed Sundays and Holidays

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