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
Copies of birth, death and other official records for Chicago and suburban Cook County residents can be obtained from the Cook County Clerk’s office at www.cookcountyclerk.com or (312) 603-5656.
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
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