Medical Records

Release of Information

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

How to Request a Copy of Your Medical Records

Print and complete the Authorization to Use and Disclose Protected Health Information form below:

Medical Records Request Form

The release form must be completed, dated and signed

If you have any questions regarding release of health information, please call 217-854-3141 x408.

Mail form to:
Carlinville Area Hospital
20733 North Broad
Carlinville, IL 62088
Attn: Medical Records