Medical records

CHI Memorial can provide you with a copy of your health information. Such documents may include:

• Notes and records associated with a particular condition
• Handwritten or dictated notes for the treatment dates you request
• Surgical reports
• History and physical reports
• Discharge summary reports
• Consultations
• Lab reports
• Radiology reports
• Pathology reports
• Physical occupational or speech therapy notes
• Reports from other specialized tests, such as cardiac catheterization, stress tests, EEG, EKG, MRI, CT, EMG, etc.

To request a copy of your medical information, please complete the CHI Memorial Authorization to Release Patient Health Information form below. We will need the following information in order to process your request:

• Personal identification (photo ID) to verify that you are the patient (or legally authorized representative entitled to the release of information.
• Name and birth date
• Name of provider or organization authorized to release the information CHI Memorial
• Name of the person or organization to whom CHI Memorial may release the information
• Description of specific information to be released
• Purpose or need for the information
• Signature of the individual (patient or legally authorized representative) and date