Medical Records
Medical Records
The Health Information Management Department (HIM) provides copies of medical records related to the care and treatment provided at Thorek Memorial Hospital.
HIM does not provide copies of radiology film. Such requests should be directed to the Radiology Department at 773-975-6756.
To request a copy of your medical records please complete and sign the Authorization for release of information form. (The form is available in English or in Spanish.) You can either download the form or call 773-975-6813 to request a form.
Please include the following information:
- Patient’s full name
- Date of Birth
- Social security number (optional)
- Telephone number
- Date of service
- Complete name and mailing address to send copies
The fee for patients to obtain copies of their medical records is postage plus the following charges: (735 ILCS 5/8-2001)
| Number of Pages | Charges |
| Pages 1-25 | $ 0.89 |
| Pages 26-50 | $ 0.59 |
| Pages 51 and more | $ 0.30 |
Records being sent directly to a physician or a healthcare facility are provided at no charge to the patient.
If you have questions regarding your request, please contact the HIM department at 773-975-6813, Monday – Friday, 8:00am – 4:00pm (excluding holidays)
Please mail your request to:
Thorek Memorial Hospital
Health Information Management Department
850 W. Irving Park RoadChicago
Chicago, IL 60613-3098
Faxed forms are not accepted.
