Request Medical Records
Cook County Health patients can request a copy of their Medical Records by submitting a Medical Record Authorization Release form either in-person or by mail/fax.
To request a copy of your medical records:
- Fill out the Medical Record Authorization Release form, click on the link below to download.
- Medical Record Authorization Release – English
- Medical Record Authorization Release – Spanish
- Medical Record Authorization Release – Polish
- Include a copy of a Valid Photo ID (passport, driver’s license, state ID or school ID). Note that a copy of a valid ID is required before processing.
Your request can be mailed/fax or submitted in person at any of the following locations:
John H. Stroger, Jr. Hospital*
1969 W. Ogden Ave., Room 1690
Chicago, IL 60612
Phone: (312) 864-6152
Fax: (312) 864-9890
Provident Hospital
500 E. 51st St., Room 1016
Chicago, IL 60615
Phone: (312) 572-1527
Fax: (312) 572-1524
*All health center records can be obtained here.
Payments & Rates
Once your request is completed, your medical records and a corresponding bill will be mailed to you.
The rates are outlined in the chart below, and you can pay by check or online at www.healthportpay.com.
Original Medical Record Format | Method of Delivery | Estimated Fee |
|---|---|---|
Electronic Medical Records | Delivered on CD or USB | $6.50 flat fee |
Electronic Medical Records | Produced to paper | $0.90 flat fee electronic to paper $0.32 for envelope plus postage $0.05 per page of paper |
Hybrid (part electronic, part paper) | Produced on CD and USB | $6.50 flat fee for electronic portion $1.08 flat fee for a CD or USB for paper converted to electronic format Plus $0.07 per page of paper record |
Paper Records | Delivered in paper form | $0.32 for envelope plus postage with additional $0.12 per page of paper |
Paper Records | Delivered via CD or USB | $1.08 for CD and USB with additional $0.07 per page of paper |
To Obtain Vital Records
To Obtain Images
To request images, please contact:
Radiological Images: (312) 864-7070
Mammography Images: (312) 864-3805
Other Departments
To contact other departments, please see the numbers below.
Patient Support Center/Scheduling Options: (312) 864-0200
Billing Records: (866) 223-2817
Patient Referral Support Center, Fax: (312) 864-7039