Medical Records

Release of information

A patient or their legal representative may inspect or obtain a copy of their medical records or have copies of medical records sent to another facility. Carlinville Area Hospital & Clinics requires a completed and signed Authorization for Release of Health Information form before releasing any documents to anyone, including the patient.

Request a copy of your medical records

Print and complete the Authorization to Use and Disclose Protected Health Information form.
The release form must be completed, dated, and signed. If you have any questions regarding release of health information, call 217-854-3141 ext. 408.

Fax form to:  217-854-6921


Mail form to:

Carlinville Area Hospital
20733 N. Broad St.
Carlinville, IL 62088
ATTN: Medical Records