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Health Information Record

Copy fees are required for obtaining your Protected Health Information from Alexian Brothers Medical Center. Fees are:

  • $.97 per page (1-25 pages)
  • $.65 per page (26-50 pages)
  • $.32 per page (51 or more pages)
  • $1.60 per page for microfilm/microfiche

You may obtain a health information authorization form by either downloading the authorization form listed below or by calling the Health Information Management office at 847-437-5500, extension 4087. Except when requested by a physician's office or in an emergency, records will be mailed.

You may mail your completed authorization form to Alexian Brothers Medical Center, 800 Biesterfield Road in Elk Grove Village, 60007 or fax it back to our Health Information Management staff at 847-472-1457. Your records will be ready in approximately 7-14 working days. If you wish to pick up your records, please write "will pick up" in the lower left corner of the form. We will call you when they are ready. Photo identification is required before we can release your records.

Authorization Form

Alexian Brothers
Medical Center

800 Biesterfield Road
Elk Grove Village, IL
60007
847-437-5500
Alexian
Rehabilitation Hospital

935 Beisner Road
Elk Grove Village, IL
60007
847-640-5600
St. Alexius
Medical Center

1555 Barrington Road
Hoffman Estates, IL
60169
847-843-2000
Alexian Brothers
Behavioral Health
Hospital

1650 Moon Lake Boulevard
Hoffman Estates, IL
60169
800-432-5005
Alexian Brothers
Women & Children's
Hospital

1555 Barrington Road
Hoffman Estates, IL
60169
847-843-2000
  • Primary Care
  • Addison
  • Barrington
  • Bartlett
  • Bloomingdale
  • Elgin
  • Elk Grove Village
  • Hanover Park
  • Itasca
  • Mt. Prospect
  • Palatine
  • Palatine/Rolling Meadows
  • Poplar Creek
  • Schaumburg
  • Streamwood
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