OSF Saint Elizabeth Medical Center

Ottawa, IL

OSF Saint Elizabeth Health Information Services is keeper of medical records for these type of visits:

How do I request a copy of a medical record for myself or someone else?

Please choose a category below to access the appropriate forms needed. You will need to print and complete the necessary form(s) including date and signature. Please review the options below for submitting your request.

• I am a patient requesting my own records.

• Request for Access to PHI by Patient or Patient Representative form

  Important Note: To request sensitive information such as mental health/developmental disability, sexually transmitted disease and /or alcohol/drug abuse, genetic testing or HIV/AIDS, print and complete the Authorization to Use or Disclose Health Information form.

• I am a patient wishing to release my records to a third party.

• Request for Access to PHI by Patient or Patient Representative form

  Important Note: To request sensitive information such as mental health/developmental disability, sexually transmitted disease and /or alcohol/drug abuse, genetic testing or HIV/AIDS, print and complete the Authorization to Use or Disclose Health Information form.

  In addition to the form provided above, you must provide evidence of Authority under applicable law to act on behalf of the patient, e.g. Patient guardian, healthcare power of attorney or other advanced directive. If already on file at OSF, please call (815) 431-5279.

  Health Care Power of Attorney
  If patient is currently making decisions for themselves, then patient completes the form. 

  If patient has chosen to allow HC-POA to make decisions for them or physician has determined patient lacks ability to make decisions for themselves, then HC-POA completes the form and provides evidence of Authority under applicable law to act for the patient.

• I am a patient representative or guardian.

• Request for Access to PHI by Patient or Patient Representative form

  Important Note: To request sensitive information such as mental health/developmental disability, sexually transmitted disease and /or alcohol/drug abuse, genetic testing or HIV/AIDS, print and complete the Authorization to Use or Disclose Health Information form.

• I am the guardian of a minor patient (under 18 years of age).

• Minors who are emancipated, married or pregnant or parents completes the Request for Access to PHI by Patient or Patient Representative form. Please provide evidence of guardianship, emancipation or other legal authority when applicable.
  
  Parent (which include parents who are below 18 years of age) or guardian of minors completes and signs the Request for Access to PHI by Patient or Patient Representative form.

  Important Note: To request sensitive information such as mental health/developmental disability, minors age 12-17 must sign the Authorization to Use or Disclose Health Information form. Minor may be need to sign the Authorization to Use or Disclose Health Information form before release can be made for other sensitive information such as sexually transmitted disease and/or alcohol/drug abuse, genetic testing or HIV/AIDS in accordance with applicable confidentiality laws.

Submitting a Request
Please scan form(s) or attach legible photo of the form(s) and return by email attachment to SEMC.ROI@osfhealthcare.org . Or, choose from one of the following options:

• Return by fax to (815) 431-5503.
• Return by US Mail to our mailing address:

OSF Saint Elizabeth Medical Center
Health Information Services
1100 E. Norris Drive
Ottawa, Illinois 61350

For additional assistance, please call (815) 431-5279.

Who else should I contact if I need records or information from other departments?

How do I request a copy of a birth certificate?
Call the LaSalle County Vital Statistics Office at (815) 434-8202.

How do I request a copy of a deceased patient’s medical record?
Call (815) 431-5279 for more information.

What options are there for receiving my medical records?

If you would like to choose how your medical records are delivered, please indicate your preference on the request for access or authorization form before submitting.

Please note: Visit dates from 6-15-13 to present can be delivered by OSF MyChart or email. Prior visits may be delivered by US mail. Fax is not an option to deliver medical information to patients, insurance, attorneys or other third parties.

OSF MyChart
Estimated turnaround time is same day to 3 business days.

1. If you are already signed up, call (815) 431-5279 to initiate your request.

2. If you have not yet signed up, go to www.osfmychart.org .

   1. Call (309) 655-2257 to initiate your request.

   2. If you need assistance with your OSF MyChart account, call (855) 673-4325.

Email
Estimated turnaround time is 3 to 5 business days.

US Mail
Estimated turnaround time is 3 to 10 business days. US Postal Service handling of incoming and outgoing mail may affect actual turnaround time.