Medical Records & Documents
Obtaining Medical Records
Your medical record is a confidential document, so your written authorization is required before a copy can be released. A fee may be required to provide records for personal use. Patient related information may also be released to a physician or medical facility for follow-up and continued care of the patient.
To collect requested documents return completed forms to the Health Information Department at the appropriate SIH Hospital.
Medical Records Request FormIf you’re 18 or older download and complete this form to access records and/or bills.
Personal Representative Authorization FormUse this form to give another individual authorization to request documents on behalf of the patient.
Request for Amendment of Protected Health Information FormUse this form to request a change to your medical, billing, enrollment, payment, claims adjudication, case or medical management records.
- Memorial Hospital of Carbondale —
Phone: 618.549.0721 ext. 65460 | Fax: 618.529.0428
- Herrin Hospital — 618.942-2171 ext. 35126 | Fax: 618.988.6182
- St. Joseph Memorial Hospital — 618.684.3156 ext. 55472 | Fax: 618.529.0534