The Medical Record Department is available to fulfill requests for medical information. A nominal fee may be charged for copies in accordance with state guidelines, except those directly sent from ALMH to another health care facility, doctor's office or hospital.
To protect confidentiality, the patient must complete and sign a Release of Information form before any information is released.
The paper form is available in the Medical Record Department. The form is also available electronically in PDF format.
Completed forms can be:
- Faxed to (217) 732-2936
- Mailed to 200 Stahlhut Drive, Lincoln, IL 62656
- Emailed to firstname.lastname@example.org
- Personally delivered to ALMH
The Medical Record Department's hours are Monday through Friday, 8 a.m. to 4:30 p.m. Before picking up copies of your record, a photo ID such as a driver's license will be required.
HIPAA Authorization to Use and Disclose Health Information (Medical Release Form)
To download the PDF file, Adobe Acrobat Reader is needed.