Requesting Your Medical Record

You may download a copy of the Release of Information Authorization by clicking here.

You may request a copy of your chart for yourself, to transfer your records, or for any reason in order to receive quality healthcare.

Once you have filled out the form, either mail it to 1025 Maine Street, Quincy, IL 62301 or fax it to 217-223-6944. By law, copies of records may take up to 30 days to receive, please call as soon as possible if you need your records for an out-of-town appointment.

To check on the status of your request, please call 217-222-6550 ext 3793.

Patients also have the right to view their medical records. You may arrange a viewing of your records through the Electronic Health Record (EHR) Department. Please email Vicki Marshall, EHR Coordinator, or call 217-222-6550 ext 3077.

Click here to view our Notice of Privacy Practices.