Medical Records Requests

Mercy’s Health & Information Management (HIM) department is responsible for managing your medical information, including medical records requests, for care provided at Mercy Hospital & Medical Center and Mercy Medical Group physicians. In compliance with state and federal regulations, all medical record requests must be submitted in writing.

How to Request Your Records

To request a copy of your medical records, please complete the appropriate Authorization for Release of Health Information form below and deliver it in person, mail or fax. Please be sure to download and review the instructions as well.

Download an authorization form (PDF)

1. Complete the form, in its entirety, following the instructions above.
2. Sign the form and submit it via one of the methods below. All sections must be complete, and the form must be signed by the patient, or the patient’s legal guardian/legal representative.

Send your request to: 

Health Information Management  
Mercy Hospital & Medical Center 
2525 S. Michigan Avenue  
Chicago, IL 60616 

Forms may also be dropped off in person, at the Health Information Management department, Monday through Friday, 8 am to 4:30 pm, faxed to 312-674-8561, or submitted via email to mercy.status@recordconnectinc.com

Please allow 7 to 14 days for processing.

Record Connect

Mercy has partnered with RecordConnect to process and fulfill your medical record copy requests. RecordConnect is a professional ROI service provider specializing in ROI enterprise services to clinics, medical facilities and hospitals. Mercy Hospital and Medical Center has engaged RecordConnect to provide ROI services on its behalf. Any compliments or complaints about RecordConnect’s services can be delivered directly to RecordConnect at (312) 757-5020 or via email at customer.service@RecordConnect.com.

Cost & Payment

There is no cost for PHI which is sent directly to another physician or medical provider.  If you would like a copy of your record for yourself or to go to someone who is not a medical provider there is a cost for this service.  The cost for these records is $1.00 for each page 1 to 25, $.66 for each page 26 to 50, $.33 for each page in excess of 50, $1.66 for each microfilm page.   Radiology images will be provided on CD or DVD for a cost of $25.00.  All fees are in accordance with Illinois and federal law.

If there is a fee for your record, RecordConnect will provide you with an invoice summarizing the charges.  You can pay over the phone by calling (312) 757-5020 or by mailing a check to the address listed on your invoice.

Delivery

Records requested by the patient can be sent by secure e-delivery, picked up in the Health Information Management Department at 2525 South Michigan Avenue, Chicago, Illinois 60616 or mailed out.  Please specify your preferred delivery method when making your request.  Please allow 7 to 10 days from the submission of the request or if there is a charge from the payment of the charges for your request to be completed.

Questions

If you have any questions about this information or other questions that come up during or after the release of information process, please don’t hesitate to call 312.567.2104 or you can reach us via email at mercy.status@recordconnectinc.com.

Birth Certificate Requests

Mercy Hospital does not process birth certificate requests. Birth certificate copies may be requested at the Illinois Department of Public Health. For more information, please visit the Illinois Department of Public Health website at this address: http://www.idph.state.il.us/vitalrecords/births/Pages/order.htm