Medical Records & Documents
Obtaining Medical Records and Billing Records
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) gives you rights over your health information, including the right to get a copy of your information and make sure it is correct.
You can ask to see or get a copy of your medical records and other health information. If you want a copy, Southern Illinois Healthcare requires your or your personal representatives signed authorization. We ask for this authorization as a method to confirm your identity. We do not charge you a fee for the copy.
To obtain a copy of your medical record or billing record, complete the Patient/Personal Representative Request for Access to Health Information form that can be found below. You have several options to return this form to us: 1) mail the form to the Health Information Department 2) send us an email with the form attached* 3) bring the form to an SIH or SIH Medical Group Health Information Department. You will receive you copies no later than 30 days from the date we receive your request.
*Sending your personal health information to an email address is not a secure delivery method and may expose your health information to others. By choosing this delivery method, you release Southern Illinois Healthcare/Southern Illinois Healthcare Medical Group from any liability involving a potential or actual breach of your health information.
If you’re 18 or older download and complete this form to access medical records and/or bills Medical Records Request Form
Use this form to give another individual your rights to access or amend with your medical or billing records.Personal Representative Authorization Form
You can ask to change any information in your medical record or billing record if you think that the information is missing, inaccurate or incomplete. To request an amendment to your medical record or billing record, complete the Request for Amendment of Protected health Information form that can be found below. You will receive our response to your request within 60 days from the date we receive your request. Request for Amendment of Protected Health Information Form
- Memorial Hospital of Carbondale/St Joseph Memorial Hospital —
Phone: 618-457-5200 ext 65460 | email@example.com / firstname.lastname@example.org
- Herrin Hospital — 618-942-2171, ext 35126 | email@example.com