Medical Records Request

Print and fill out the Release of Information (ROI) Form below:

 
You may submit your request:

  • Via fax to 312-926-3093 (Attention: Health Information Management)
  • Via mail to Health Information Management, 541 N Fairbanks, Suite 1475, Chicago, IL 60611
  • If you need to speak to a representative about the status of your request please call 312-926-3376

Patients' Privacy Rights

Under the Health Insurance Portability and Accountability Act (HIPAA), patients have the following rights:

  • To request a change or amendment to their health information if they believe there is an error
  • To obtain a listing of individuals and/or organizations that have received their health information from Northwestern Memorial HealthCare clinical affiliates; this is also known as an Accounting of Disclosures
  • To restrict disclosures of their health information

Please print and complete the appropriate form and submit your request to:

Northwestern Memorial Hospital
Health Information Management
251 East Huron
Lower Concourse / L340
Chicago, IL 60611

NMHC Amendment Request

NMHC Patient Request for Accounting of Disclosure     

NMHC Request for Restriction of Protected Health Information