Medical Records | Billing | Loyola Medicine

Medical Records

About Your Medical Records

At Loyola Medicine, we are sensitive to the private nature of your medical records. We take steps to assure that your medical records are kept confidential and secure.

Loyola Medicine participates in a health information exchange. Find out more about our Health Information Exchange.

Loyola Medicine has an online patient portal (MyLoyola) that enables you to securely manage and receive information about your health online. Find out more about our patient portal (MyLoyola).

Medical Record Requests

To obtain your medical records, you will need to complete an Authorization for Release of Protected Health Information Form (Spanish, Polish). A copy of a valid photo ID must be submitted with the authorization and/or shown when medical records are picked up.

If the records requested are for a deceased patient, you must provide one of the following with the authorization:

  1. Executor or Administrator of the deceased person's estate
  2. An agent appointed by the deceased under a power of attorney for health care
  3. Authorized Relative Certification form with a copy of the death certificate

To authorize Loyola Medicine to release your medical record information associated with work-related injuries, you will need to complete the Authorization for Release of Protected Health Information for Work-Related Injuries form.

Medical Record Charges

Patient Abstract (Pertinent Information including physician notes, operative reports, radiology reports, lab reports): Free

Complete Patient Electronic Copy: $6.50

Complete Patient Paper Copy: Illinois State Comptroller Fee Schedule (Capped at $50)

Return the necessary forms to the appropriate hospital:

Loyola University Medical Center
Attn: Release of Information
2160 S. 1st Ave.
Maguire Building, Room 0856
Maywood, IL 60153
Phone: 708-216-3665
Fax: 708-216-5615
E-Mail: ROI@LUHS.ORG

Gottlieb Memorial Hospital
Attn: Release of Information
701 W. North Ave.
Melrose Park, IL 60160
Phone: 708-538-4162
Fax: 708-538-5184
E-Mail: GMHROI@LUHS.ORG

MacNeal Hospital
Attn: Release of Information
3249 Oak Park Ave.
Berwyn, IL 60402
Phone: 708-783-3310
Fax: 708-783-6071
E-Mail: MNHROI@LUHS.ORG

You may download the Authorization for Release of Protected Health Information Form (SpanishPolish) from this website or call 708-216-3665 to request an authorization form.

Medical record requests for legal reasons must be accompanied by a patient’s signed Authorization for Release of Protected Health Information form or a valid subpoena or court order to release the medical records.

Loyola Radiology Imaging

Phone: 708-216-3921

Birth and Death Certificates

The Cook County Clerk's office maintains official birth and death certificates.

Billing Record Requests

To obtain your billing records, you will need to complete an Authorization for Release of Protected Health Information Form (SpanishPolish). A copy of a valid photo ID must be submitted with the authorization and/or shown when medical records are picked up.

If the records requested are for a deceased patient, you must provide one of the following with the authorization:

  1. Executor or Administrator of the deceased person's estate
  2. An agent appointed by the deceased under a power of attorney for health care
  3. Authorized Relative Certification form with a copy of the death certificate

Return the necessary forms to the appropriate hospital:

Loyola University Medical Center
Attn: Release of Information
2160 S. 1st Ave.
Maguire Building, Room 0856
Maywood, IL 60153
Phone: 708-216-3665
Fax: 708-216-5615
E-Mail: ROI@LUHS.ORG

Gottlieb Memorial Hospital
Attn: Release of Information
701 W. North Ave.
Melrose Park, IL 60160
Phone: 708-538-4162
Fax: 708-538-5184
E-Mail: GMHROI@LUHS.ORG

MacNeal Hospital
Attn: Release of Information
3249 Oak Park Ave.
Berwyn, IL 60402
Phone: 708-783-3310
Fax: 708-783-6071
E-Mail: MNHROI@LUHS.ORG