Request Medical Records
Request Medical Records & Authorization Forms
Form: Request Medical Records
Send completed form to:
Health Information Management Department
6800 State Route 162
Maryville, Illinois 62062
Attorneys and third party requestors complete the HIPAA Authorization Form and mail to the address above.
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.
If you are a Healthcare Provider: 618-391-6100
If you are the Patient: 618-391-6102