In order for Riveredge Hospital to release any medical records, an “Authorization to Use or Disclose Protected Health Information” must be completed to obtain them. This form must be completely filled out, signed and dated.
For patients under the age of 12, the parent or legal guardian must complete the form. For patients age 12-17, the patient must sign. Medical records for patients age 12-17 will not be released without their signature.
For patients age 18 and older that have been deemed unable to sign for themselves, a court order or letter of office must be submitted with the completed authorization.
There will be no charge for an abstract of the record if the information is being requested by an aftercare provider. All other requests will be charged a fee based on the state of Illinois copying fee schedule. Once the authorization form is received, it will be processed and an invoice will be sent with the records.
To download the form, click here.
Once the authorization form is received, medical records will be processed within seven to 10 business days.
Health Information Management Department
8311 W. Roosevelt Rd.
Forest Park, IL 60130
Completed authorizations can be faxed to 708-771-8409.
If the records are needed for educational purposes, please call the Health Information Management Department to obtain the “Authorization for Education Planning and Placement.”
For any questions regarding release of information, please call the Health Information Management Department at 708-771-7000, ext. 3160 or ext. 4160.