Medical Records

Patients treated at Hopedale Hospital obtain HOSPITAL records by completing the appropriate authorization and release and sending to our Medical Records Department:

How to Request Medical Records

You will need Adobe Acrobat Reader (Download) installed to download the following form.


Hopedale Hospital

If you are requesting medical records FROM Hopedale Hospital to be sent TO another healthcare provider:

First… Complete this HOSPITAL Authorization for Access/Release of Information form. A copy charge may apply.
Then, fax or mail to Hopedale Hospital
HIM Department (Medical Records)
107 Tremont St.
PO Box 267
Hopedale, IL 61747
Fax: 309.449.4087
For questions, call 309.449.4283

 

If you are requesting for medical records FROM another healthcare provider to be sent TO Hopedale Hospital:

First… Complete this Authorization for Access/Release of Information form
Then, forward records ‘Confidential’ to Hopedale Hospital
HIM Department (Medical Records)
107 Tremont St.
PO Box 267
Hopedale, IL 61747
Phone: 309.449.4283

Hopedale Medical Arts Physicians’ Offices

If you are requesting for medical records FROM a Hopedale Medical Arts doctor to be sent TO another healthcare provider:

First… Complete this Authorization for Access/Release of Information form.Please use the form(s) in if you are a patient at:

  • Medical Arts Physicians’ Office
  • Atlanta Doctors Office
  • Delavan Doctors Office
  • Mackinaw Doctors Office
  • Manito Doctors Office
Then, fax or mail to Medical Arts Physicians’ Records
107 Tremont St.
PO Box 567
Hopedale, IL 61747Fax: 309-449-4087
For questions, call 309.449.4283

 

If you are requesting medical records FROM another doctor or healthcare provider to be sent TO Hopedale Medical Arts doctor’s office:

First… Complete this Hopedale MEDICAL ARTS Physicians’ Authorization for Access/Release of Information form
Then, forward Records ‘Confidential’ to Medical Arts Physicians’ Records- Confidential
107 Tremont St.
PO Box 267
Hopedale, IL 61747Phone: 309.449.4283

When Completing Request Forms

Specify in your request what medical information you want and over what time period. Please be as specific as possible. Be sure to include the patient’s:

  • Full Name
  • Date of Birth
  • Current Address
  • Current Phone Number
  • Dates of Service

Applicable Fees

If copies are going from HMC directly to another physician or hospital, there is no charge. If copies of your medical records are to be sent directly to you, there is a fee of .65 cents per page.