To request medical records, please submit a completed authorization form (see below) signed by the patient to the Health Information Management Department. We will process your request within two business days of receiving it.
You may appear in person at Memorial's Health Information Management department to pick up your records. We are in Room G163 (you will use the Lincoln elevators). You may be able to pick up your records same day as your request, as time permits. Or, records can be mailed directly to your home.
Patients who pick up their records in person must bring photo identification. A small copying fee may apply.
Memorial's authorization form is available for download below. You will need Adobe Acrobat Reader installed in order to read the downloaded file.
If you would like to request a copy of the form mailed directly to your home or have questions, contact the Health Information Management Department at 217-788-3550.
HIPAA Authorization to Use and Disclose Health Information (Medical Release Form)
Release of Information instruction sheet (This document explains each section of the HIPAA Authorization form.)
Birth Certificate Requests
Please contact the Sangamon County Clerk's Office with birth certificate requests. Call 217-753-6700, or visit SangamonCountyClerk.com.