Medical Records

At Loyola University Health System, we are sensitive to the private nature of a patient’s medical record. We take steps to assure that your medical records are kept confidential and secure.


How to Obtain Medical Records

A patient should complete an authorization for release of health record information form (Spanish, Polish).

If the records requested are for a deceased patient, you must provide legal documentation showing, executor or administrator of the deceased patient’s estate, agent appointed by the deceased under a power of attorney for health care 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 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:

Gottlieb Memorial Hospital
Medical Records Department
701 W. North Ave.
Melrose Park, IL 60160

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.

If you would prefer to receive a form by mail, please call 708-538-4162 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.

Electronic Exchange of Health Information

Loyola University Health System is participating in Health Information Exchanges. This enables LUHS to share a patient’s electronic health information with outside providers involved in a patient's care, such as hospitals, nursing homes, home care agencies and non-LUHS physicians. In turn, an LUHS physician can obtain a patient’s records from outside health-care providers to help form a more complete picture of the patient’s condition.

How to Participate

LUHS will obtain a patient’s signed consent before sharing health information electronically. Consent will be obtained as part of a visit with a health-care provider. A patient can revoke such consent at any time. To revoke consent, a patient would complete a revocation of consent form and mail it to the address listed on the form.

For More Information

To help you understand how the electronic health information exchanges work, we have compiled a set of answers to frequently asked questions

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