Medical Records Request

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How to Request a Copy of Your Medical Record

Request and Authorization to Release Health Information

Acknowledgment of Medical Record Request Processing Fee

Where to Send Your Completed Authorization Forms

Get the Status of Your Release of Information Request

How to Request a Copy of Your Medical Record

To maintain patient confidentiality and assure compliance with federal and state privacy laws, health information may not be released without a patient’s written authorization (except as permitted by law). Aunt Martha’s partners with Healthport for the release of medical information.

The information below describes the process of requesting medical records that you may have at Aunt Martha’s Health & Wellness. The steps involved depend on what records you want provided and/or for whom you want your records provided to.

In most cases, you will need to download and submit the following documents:

Request and Authorization to Release Health Information

Acknowledgment of Medical Record Request Processing Fee

Where to Send Your Completed Authorization Forms

Signed and completed authorization forms may be submitted in person, by fax or by mail:

In Person

Bring your form to any Aunt Martha’s health center location.

By Fax (with copy of ID)

708.747.7928

By Mail

Aunt Martha’s Health & Wellness
ATTN: Medical Records
19990 Governors Hwy
Olympia Fields, IL 60461

Already submitted your request?

Get the Status of Your Release of Information Request

If you completed a Release of Information Form and would like to inquire about the status of your request, please contact Healthport at 1-800-367-1500.

• You need to specifically ask to include information about HIV testing, mental health, alcohol and/or drug use counseling when you ask for a copy of your medical record.
• A licensed professional reviews all mental health records prior to release.
• Your record may not be available if it has been more than 7 years since your last visit.