If you need a copy of an existing birth certificate, please contact the Virginia Department of Health, Office of Vital Records. Medical Records, 44045 Riverside Parkway, Leesburg, VA 20176 Inova Medical Group Medical Records, 2501 Parkers Lane, Alexandria, VA 22306 Inova Loudoun Hospital Medical Records, Attn: Release of Information, 3300 Gallows Road, Falls Church, VA 22042 Inova Mount Vernon Hospital Medical Records, Attn: Release of Information, 3600 Joseph Siewick Drive, Fairfax, VA 22033 Inova Fairfax Hospital, Inova Children's Hospital, Inova Heart and Vascular Institute, Inova Emergency Care Center – Fairfax and Inova Emergency Care Center – Reston/Herndon Medical Records Department, 4320 Seminary Road, Alexandria, VA 22304 Inova Fair Oaks Hospital Inova Alexandria Hospital and Inova Healthplex – Franconia/Springfield Appropriate address and fax numbers, along with a contact number for more information, are listed further below on the page.Īuthorization to Release/Disclose Protected Health Information forms
How to request your deceased relative's recordsTo receive a copy of your medical record, print out and complete our authorization form below and mail or fax it to the hospital or facility where you received service. Please allow seven to 14 days for processing. Medical Records Department at (708) 660-4026 You can view a list of fees associated with this service here.
The PDF form is available here in English, Spanish or Mandarin.
Download a form, which authorizes Rush to release your health information.Address: Medical Records Department, 520 S.Rush Copley Health Information Managementįor questions regarding your physician office records, please call (630) 692-5950.
We are unable to accept walk-in requests. Mail or fax the completed form to the address or fax number below.Fill out the information requested on the form.How to request your physician office records The signed form, along with a copy of the death certificate, can be hand delivered or mailed to the address below:.Fill out all of the information on the form, including the signature of the authorized relative.If your relative has passed away, you can request copies of their medical records by completing a relative certification form, in addition to the Authorization to Release Health Information form.How to request your deceased relative's hospital records Medical Records Department (lower level of hospital) The signed form can either be hand delivered or mailed to the address below or sent via fax to the fax number below:.The PDF form is available here in English or Spanish. Address: Medical Records Department, lower level of hospital, 2000 Ogden Ave., Aurora, IL 60504.Please contact the Medical Records Department with any questions. Our third-party vendor called Verisma processes all legal requests. Please allow seven to 14 days for processing. 1919 Thomas Road Phoenix, AZ 85016 Fax: 60 Status Check After ten business days, email and include your child’s first, last name and date of birth. Fill out all of the information on the form.If your relative has passed away, you can request copies of their medical records by completing an authorization form.How to request your deceased relative's records Please allow seven to 14 days for processing. Sign the form and send it to the address below:ĪTTN: Health Information Management Office.Fill out the information on the form, indicating the records you are requesting and the specific date of your visit.Harrison St., Suite 001, Chicago, IL 60612 Address: Health Information Management Office, 1611 W.Please contact the Health Information Management Office with any questions.