Patients and Visitors at Alexian Brothers Neurosciences Institute
Health Information Records
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 will need to fill out a completed authorization form in order to obtain your health information records. 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
Attn: Health Information Management
800 Biesterfield Road
Elk Grove Village, IL 60007
or
Fax it to 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
