Saint Anthony Hospital has partnered with Ciox Health to process and fulfill your request.
An Authorization to Release your records can be downloaded below, or picked up at the Health Information Management Department (Medical Records) on the hospital second level.
Release of Medical Records Authorization Form (English) (PDF: 1 page / 46 KB)
Release of Medical Records Authorization Form (Spanish) (PDF: 1 page / 152 KB)
If you choose to download your request, simply download, print, complete and sign the forms.
Health Information Management (Medical Records) Department
Saint Anthony Hospital
2875 West 19th Street
Chicago, IL 60623-3501
Your request will be processed within 30 days. Records can be mailed to the patient or picked up in person at the hospital. You will be notified when your records are available for pick up after the Authorization form has been received and processed. The individual who picks up the records will be asked to show two forms of photo identification.
Copies are $0.36 cents per image for the first 200 pages. The cost is reduced to $0.12 per image beyond the initial 200 pages. We will send you an invoice by mail to let you know how much the total charge will be once we retrieve your records. You may pay by credit card or check in person should you wish to retrieve your records personally.
We are open to the public at the address above between 9 a.m. and 4:00 p.m., Monday through Friday.
Should you wish to contact the Health Information Department (Medical Records), you may call 773.484.4289.