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Request Medical Records - Anderson Hospital

patients visitors feature

Request Medical Records

Request Medical Records & Authorization Forms

Form: Request Medical Records

Send completed form by mail to:

Health Information Management Department
6800 State Route 162, Suite 175
Maryville, Illinois 62062
Fax: 618-288-0024
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Instructions:

Attorneys and third party requestors complete the HIPAA Authorization Form and return by mail, fax, or the email address provided above.

Patients and legal guardians complete the Request to Access PHI Form and return by mail, fax, or the email address provided above.

 

 

If you need assistance with your request for medical records, please call the Health Information Management Department at 618-391-6100.