Patients and Visitors at Alexian Brothers Medical Center

Health Information Record

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

• $.89 per page (1-25 pages)
• $.59 per page (26-50 pages)
• $.30 per page (51 or more pages)
• $1.25 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 847-956-5148. Your records will be ready in approximately 4-7 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