Patients who enroll in our health record portal have one touch access to their care team and medical records 24/7

Medical Records Request

Jump to:
How to Request a Copy of Your Medical Record

Request and Authorization to Release Health Information

Acknowledgement of Medical Record Request Processing Fee

Where to Send Your Completed Authorization Forms

Get the Status of Your Release of Information Request

How to Request a Copy of Your Medical Record

To maintain patient confidentiality and assure compliance with federal and state privacy laws, health information may not be released without a patient’s written authorization (except as permitted by law). Aunt Martha’s partners with Healthport for the release of medical information.

The information below describes the process of requesting medical records that you may have at Aunt Martha’s Health & Wellness. The steps involved depend on what records you want provided and/or for whom you want your records provided to.

In most cases, you will need to download and submit the following documents:

Request and Authorization to Release Health Information

Choose your download.

Acknowledgement of Medical Record Request Processing Fee

Choose your download.

Where to Send Your Completed Authorization Forms

Signed and completed authorization forms may be submitted in person, by fax or by mail:

In Person

Bring your form to any Aunt Martha’s health center location.

By Fax (with copy of ID)

708.747.7928

By Mail

Aunt Martha’s Health & Wellness
ATTN: Medical Records
19990 Governors Hwy
Olympia Fields, IL 60461

Already submitted your request?

Get the Status of Your Release of Information Request

If you completed Release of Information Form and would like to inquire about the status of your request, please contact Healthport at 1-800-367-1500.

  • Records involving HIV testing, mental health counseling or alcohol and drug abuse information can only be released with a specific request from you.
  • Mental health notes must be reviewed by a mental health provider before being released.
  • Records beyond 7 years of last visit may not be available.

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When you sign up for our 24/7 online Patient Portal, you can:

  • Conveniently request and view appointments
  • Request prescription refills
  • Access test results and health information
  • Pay or view your bills
  • Communicate privately with your provider
  • Complete and print health forms
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