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.
With your consent, Loyola Medicine will share your electronic health record with outside providers involved in your care. Find out more about our electronic exchange of health information.
How to Obtain Medical Records
To obtain your medical record, you will need to complete an Authorization for Release of Health Record Information form (Spanish, Polish).
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.
If the records requested are for a deceased patient, you must provide legal documentation showing the executor or administrator of the deceased patient’s estate, the agent appointed by the deceased under a power of attorney for healthcare or a death certificate and signed Authorized Relative Certification form to obtain records.
Requests for copies of a patient’s record for legal reasons must be accompanied by a patient’s signed Authorization for Release of Health Record Information form or a valid subpoena accompanied by the Authorization for Release of Health Record Information form with Section C completed by the attorney requesting the medical records or a court order authorization for Loyola to release the medical records.
Separate forms are required for each request.
Return the necessary form(s) with the appropriate fees, based on the fee schedule, to:
Maguire Building, Room 0856
2160 S. First Ave.
Maywood, IL 60153
The fees will be adjusted annually per statute 735 ILCS 5/8-2001. No handling fee is charged to patients requesting copies of medical records.
You may download the form from this website or call 708-216-3665 to request a form.
Valid ID must be shown when records are picked up. Otherwise, records will be sent by mail and are not available by facsimile or email.
If you are not requesting specific documentation, you will be sent an abstract that typically includes history and physical reports, discharge summary, operative reports, consultations, lab, X-ray, specialized tests and most recent outpatient visits.
Learn more about Loyola’s electronic exchange of health information.