|Requesting From||Please Call|
|Radiology Imaging CD||Radiology at (815) 395-5238|
|OSF Medical Group||Your physician’s office|
|Itemized statements or bills||OSF Patient Accounts at (815) 395-4942|
|Laboratory slides||OSF Saint Anthony Medical Center Laboratory at (815) 395-5105|
|Rockford Cardiovascular Associates (RCVA)||RCVA directly at (815) 398-3000|
Please complete each section of the Medical Records Authorization Form and mail it to the OSF Saint Anthony Medical Center Medical Information department. If the form is incomplete, it may cause a delay in the completion of your request.
For continuation of care, your medical information will be sent directly to your physician/medical facility free of charge. All other requests are subject to fees in accordance with Illinois state statutes. You will be notified should there be any fees associated with your request.
Please contact with any further questions regarding your medical records.
Please be advised that we may require additional information and identification for patient safety reasons. If you have any questions or concerns do not hesitate to call us.
OSF Saint Anthony Medical Center
Attn: Medical Information Services
5666 East State Street
Rockford, Illinois 61108
Phone: (815) 395-5320
Hours: 8 a.m. – 4:30 p.m., Monday - Friday
Please note: Fax is not an option to deliver medical information to patients, insurance, or attorneys or other third parties.
Please review these instructions to assist in filling out the form:
- If there is a chance you have records under a different alias, please include all to ensure we find all the information being requested.
- Specify the dates and information being requested (if you are unsure of exact dates please give an approximate date(s) or list what information you are looking for).
- If you wish to have a copy of your X-Ray, CT, MRI or Mammogram images/films please contact the Radiology Department at (815) 395-5238.
- If you wish to have a copy of your Itemized Statement, please contact the OSF Patient Accounts & Access Center at (815) 395-4942. Allow 10 days for receipt of the itemized statement.
- In the 'disclosed to' section please specify if you would like records disclosed to you the patient, another individual, insurance office, attorney or health care facility. Please list their name, address and phone number.
- Please sign and date the authorization form to make it valid.
- If you are a parent signing for a minor child, they must be 17 or under. If the patient is 18 or over, they must sign the authorization form.
- If you are the patient's Power of Attorney for Health Care, you may sign the authorization form for information on the patient. However, if we do not have this information on file we may ask for a copy to be included with this form. If you are unsure if we have a copy on file, please call before submitting this form and we will be glad to check.
- If you are requesting records on a deceased patient, please contact Release of Information at (815) 395-5320 for more information.