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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)

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