Request Medical Records

Request Medical Records & Authorization Forms

Form: Request Medical Records

Send completed form to:

Health Information Management Department
Suite 175
6800 State Route 162
Maryville, Illinois 62062

Instructions:

Patients and legal guardians complete the Request to Access PHI Form and mail to the address above. Instructions on completing the form can be found here.

Form: Authorization to Treat Minor

This form can be filled out by parents and guardians of children to give a designated person such as grandparents, babysitters, teachers, etc. authorization to have their child treated for medical emergencies.

Phone Numbers:

If you are a Healthcare Provider: 618-391-6100 
If you are the Patient: 618-391-6102