Lake County Service Provider Records Requests
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NameWebsitePhoneFaxAddress
Request Form Link
Online Request?
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Aroura Medical Center
https://www.aurorahealthcare.org/patients-visitors/medical-records
414-979-4590414-385-1505
https://www.aurorahealthcare.org/-/media/aurorahealthcareorg/documents/patients-visitors/authorization-for-disclosure-of-protected-health-information.pdf?la=en&hash=7FDF6EAACF5AC11C01282E364554237B08EE00A5
https://www.aurorahealthcare.org/-/media/aurorahealthcareorg/documents/patients-visitors/patient-health-information-access-request.pdf?la=en&hash=F3D10052FEB38B0A86AAA581CD20E9A13C0283E9
Can request online by emailing aurorareleaseofinfo@aurora.org. Requires 2 ROIs (left) and another for BH records - https://www.aurorahealthcare.org/-/media/aurorahealthcareorg/documents/patients-visitors/authorization-for-disclosure-including-behavioral-health-information.pdf?la=en&hash=5A87C82803522DA0A0EDEBD5B29F66347FCC8F7A
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Centegra Medical Center
https://centegra.org/medical-records/
815-334-3111815-338-5139
4201 W Medical Center Dr, McHenry IL 60050
https://centegra.org/wp-content/uploads/General-Release-of-records-form-082016.pdf
BH: https://centegra.org/wp-content/uploads/20160920095646272.pdf
Can request online by emailing MyRequest@centegra.com.
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Advocate Condell
https://www.advocatehealth.com/condell/patients-and-visitors/for-patients/
847-990-5250
801 S. Milwaukee Ave. Libertyville, IL 60048
https://www.advocatehealth.com/assets/documents/subsites/condell/patientinfo/authorizationtodisclose.doc.pdf
Patient portal: https://www.advocatehealth.com/amg/myadvocate/
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Cook County Health & Hospitals
http://www.cookcountyhhs.org/patient-services/medical-records/
3 locations (see website)
http://www.cookcountyhhs.org/wp-content/uploads/2011/12/English-Auth.pdf
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Family Medicine Wauconda
https://www.fmsmed.com/locations-and-hours
847-526-2151847-526-2017
medrecs@fmsmed.com
Patient portal online: https://mycw61.ecwcloud.com/portal7803/jsp/100mp/login_otp.jsp
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Heartland Alliance
https://www.heartlandalliance.org/hho/who-we-are/contact-us/
https://hh.emrconnect.org/portal/FileFetcher.aspx?fileID=c9de0476-e4dc-4674-9b9e-0bd468adccf7
Patient portal online: https://hh.emrconnect.org/portal/default.aspx
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Kenosha Medical Center
http://www.froedtertsouth.com/Patients-Visitors/Patient-Privacy-and-Medical-Records/ , https://www.patientbank.us/providers/united-hospital-system/
262-656-2011262-656-2535
Medical Records Department Kenosha Medical Center 6308 8th Avenue Kenosha, WI, 53143
https://www.patientbank.us/providers/united-hospital-system/
Patient portal: https://uhsi.followmyhealth.com/Login/Home/Index?authproviders=0&returnArea=PatientAccess#/default
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St. Catherine's Medical Center
http://www.froedtertsouth.com/Patients-Visitors/Patient-Privacy-and-Medical-Records/ , https://www.patientbank.us/providers/united-hospital-system/
262-656-2011262-656-2535
Medical Records Department Kenosha Medical Center 6308 8th Avenue Kenosha, WI, 53143
https://www.patientbank.us/providers/united-hospital-system/
Patient portal: https://uhsi.followmyhealth.com/Login/Home/Index?authproviders=0&returnArea=PatientAccess#/default
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LCHD Belvidere Clinic
https://www.lakecountyil.gov/2576/Medical-Records
https://www.lakecountyil.gov/2591/Community-Health-Center-Locations
847-625-7240
http://www.lakecountyil.gov/DocumentCenter/View/4478
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LCHD Round Lake Park
https://www.lakecountyil.gov/2576/Medical-Records
https://www.lakecountyil.gov/2591/Community-Health-Center-Locations
847-546-0083
http://www.lakecountyil.gov/DocumentCenter/View/4478
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LCHD Zion
https://www.lakecountyil.gov/2576/Medical-Records
https://www.lakecountyil.gov/2591/Community-Health-Center-Locations
847-984-5661
http://www.lakecountyil.gov/DocumentCenter/View/4478
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Mercy Hospital
https://www.mercy-chicago.org/medical-records
312-567-2240312-567-2068
https://www.mercy-chicago.org/workfiles/Other%20Documents/Med%20Rec%20Authorization%20Form_2016.pdf
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Northshore University Health System - Evanston Hospital, Skokie Hospital, Highland Park Hospital, Glenbrook Hospital
https://northshore.org/locations
847-982-4450
847-982-4497 or 847-982-4498
https://www.northshore.org/globalassets/locations/release-of-information-form-dec-2015.pdf
Send completed release forms to releaseforms@northshore.org . There is also a patient portal: https://www.northshoreconnect.org/mychart/
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Northwest Community Hospital
https://www.nch.org/patients-visitors/access-your-medical-records
847-618-3200847-618-3249
Northwest Community Healthcare
Health Information Management Department
800 W. Central Road
Arlington Heights, IL 60005
https://www.nch.org/Portals/0/patients/RecordsAuthorization.pdf
Must send in mail
Patient portal: https://mychart.nch.org/mychart/
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Northwestern Memorial Hospital and Lake Forest Hospital
https://www.nm.org/patients-and-visitors/mynm-mychart-and-medical-records
877-973-2673
312-926-3093 or 630-938-2160
Health Information Management 4175 Chandler Drive, Hanover Park, IL 60133
https://www.nm.org/-/media/Northwestern/Resources/patients-and-visitors/northwestern-medicine-authorization-for-release-of-information.pdf?la=en
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Orchard Medical Center
http://www.orchardmedicalcenter.com/contact.php
847-395-3322847-395-0921
Patient portal: https://orchardmedicalcenter.followmyhealth.com/Login#/default
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Vista Physician Group->http://www.vistaphysiciangroup.com/vista-physician-group/location.aspx
http://www.vistaphysiciangroup.com/Uploads/Public/Documents/PhysicianPractice/DownloadFiles//Vista%20Physician%20Group%20HI%20Release.pdf
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Rush University Medical Center
https://www.rush.edu/patients-visitors/patients/request-medical-records
312-942-7262312-942-2264
Rush University Medical Center
ATTN: Health Information Management Office
1611 W. Harrison St., Suite 001
Chicago, IL 60612
https://www.rush.edu/sites/default/files/patient-health-information-2015.pdf
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Vista Health East
http://www.vistahealth.com/vista-health-system/recordsandforms.aspx
847-360-4045847-360-4143
1324 N. Sheridan Rd. Waukegan, IL 60085
http://www.vistahealth.com/Uploads/Public/Documents/Division%205/Vista%20Medical%20Center/2016/English%20ROI%20form.pdf
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Vista Health West
http://www.vistahealth.com/vista-health-system/recordsandforms.aspx
847-360-2440847-360-2879
2615 Washington St. Waukegan, IL 60085
http://www.vistahealth.com/Uploads/Public/Documents/Division%205/Vista%20Medical%20Center/2016/English%20ROI%20form.pdf
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Weiss Hospital
https://www.weisshospital.com/for-patients/your-records/request-medical-records
773-564-5845773-564-5829
4646 N Marine Dr Chicago IL 60640
https://www.weisshospital.com/docs/librariesprovider47/medical-records-forms/mh0554-authorization-for-release-of-medical-record-information-(weiss).pdf?sfvrsn=d2019b3d_2
Patient portal: https://www.weisshospital.com/login/im-a-patient
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Stroger Hospital
http://www.cookcountyhhs.org/patient-services/medical-records/
http://www.cookcountyhhs.org/wp-content/uploads/2011/12/English-Auth.pdf
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Advocate Medical Group
https://www.advocatehealth.com/amg/for-patients/release-of-information
https://www.advocatehealth.com/amg/_assets/documents/release-of-information/authorization_for_release_of_patient_health_information.pdf
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Erie Health Center
http://www.eriefamilyhealth.org/locations/erie-healthreach-waukegan/
847-666-3494855-225-3022
2323 Grand Ave., Waukegan IL 60085
http://www.eriefamilyhealth.org/wp-content/uploads/2016/05/Erie-Release-of-PHI_-12012014_Engl.pdf
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