Health Information Records at  Alexian Brothers Behavioral Health Hospital

Copy fees are required for obtaining your Protected Health Information from Alexian Brothers Behavioral Health Hospital.
Fees are as follows:

• $.86 per page (1-25 pages)
• $.57 per page (26-50 pages)
• $.29 per page (51 or more pages)

• $1.15 per page for microfilm/microfiche

Please mail your completed authorization form to:

Alexian Brothers Behavioral Health Hospital
Attention: Medical Records Department
1650 Moon Lake Blvd.
Hoffman Estates, IL 60169

-OR-

You can fax your completed form to our Health Information Management staff at 847-755-8025.

Authorization Form:  English version | Spanish version

We can mail your records to you upon request. If you wish to pick up your records in person, we will call you when they are ready.

Please note: Photo identification is required before we can release your records.