Anyone age 18 or older is authorized to sign the form.
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To request that a copy of your child’s medical records be released to you or another provider, you must complete a release of information form. The form can be returned to the address listed above via mail/fax or delivered in person.
To obtain a copy of your medical records for an adult, you must have their consent. This can be demonstrated by providing legal proof (i.e. medical power of attorney, personal representative or proof of guardianship).
Please allow 30 days for your request to be processed.
You may receive your records on paper, CD, or sent via secure e-mail.
Complete the Authorization to Release Immunization Records form and fax with your signature to (217) 524-0967 or email to [email protected]
Register for Illinois Resident Immunization Portal (Vax Verify)
If you have any questions, please call the Illinois Department of Public Health Immunization Section at (217) 785-1455