Medical Records Requests
Medical Record Inquiries
In order to receive copies of your medical records, please complete a valid Authorization to Release Health Information Form. You can either download the form from the link below or obtain it by contacting:
Health Information Management (HIM)
Phone: 312.996.3350 (Hours of Operation: 8 am - 4:30 pm, Monday-Friday).
Address: 833 South Wood Street, Suite B-52 (M/C 772), Chicago, Illinois 60612
Appropriate fees may apply: Fee Schedule for copies of records.
- Authorization for Release of Health Information Form (English) Download (pdf)
- Authorization for Release of Health Information Form (Spanish) Download (pdf)
- Authorization for Release of Electronic Delivery of Health Information Form Download (pdf)
Send Authorization for Release of Health Information Form:
- By US Mail (Health Information Management, 833 South Wood Street, Suite B-52 (M/C 772), Chicago, Illinois 60612)
- By fax: 312.413.2822
- By email to recordrequest@uic.edu
