Patients and Visitors

Request Radiology and Imaging Records

Who can sign up to get health information for a patient:

• The patient (Not the spouse)
• Power of Attorney if the patient is not able to sign (Legal document must be provided)
• Parent (If the patient is younger than age 18)
• Parent and minor if the patient is 12 to 17 years of age and is getting psychiatric, alcohol, or drug treatment services
• Legal guardian (Proof of guardianship document must be provided)
• Representative of the estate of a patient who expired. A copy of the death certificate and a copy of the representative of the estate must be provided
• Referring Provider

To Request Radiology and Imaging Records

1. Download an authorization form below to allow UI Health to release your radiology imaging information.
   
   • Authorization for Release of Health Information Form (English, pdf) 
   • Authorization for Release of Health Information Form (Spanish, pdf)
2. Fill out the entire form including the type of records and dates of your visits.
3. Sign the form and send it to Health Information Management:

Walk-In Location (Pick-up same day):

UI Health
Health Information Management (HIM)
1740 W. Taylor, Admitting Department Suite 1100, Chicago, Illinois 60612
Phone: 312.996.3350
Hours: 8 am - 4 pm, Monday - Friday

By Mail:

UI Health
Health Information Management Dept. MC772
833 South Wood Street, B52
Chicago, IL 60612
Phone: 312.996.0272
Fax: 312.413.9631 or email the completed form to: recordrequest@uic.edu

Cost of Radiology Images through Medicom Patient Link

• There is no cost to patients requesting their own radiology images through Patient Link.
• There is no cost for radiology images sent directly to other healthcare providers through Patient Link.
• Requests for radiology images from third parties are charged a $25.00 processing fee.

If your relative has expired, you can request copies of their radiology images if:

1. You are the power of attorney for health care that goes beyond the patient’s death, or you are the administrator of the estate. You must provide a copy of the legal document and the death certificate.
2. You are an authorized relative if you are the surviving spouse of the patient who has expired. If there is no surviving spouse, you are an authorized relative if you are the eldest child, a parent, sibling, or other relative that is named and defined in the Illinois rules of interstate succession (755 ILCS 5/2-1).

How to request the radiology images of a relative who has expired:

1. Download an authorization form below to allow UI Health to release deceased relative radiology imaging information.
   
   • Authorization for Release of Health Information Form (English, pdf) 
   • Authorization for Release of Health Information Form (Spanish, pdf)
2. Send the authorization, a copy of the administrator of the estate, and a copy of the death certificate to the location as noted above.

Please allow 3 to 5 business days for processing.