Contact DCHD

To obtain a copy of your medical record, you will need to complete the "Authorization to Release and Disclose Client Information" form:

Release of Information Form (English)

Release of Information Form (Spanish)

The release of client medical information is governed under federal and state laws. 


To release or obtain your medical information from the DuPage County Health Department, you must:

  • Complete all sections of the Authorization to Release Client Information
  • Hand-deliver, mail, or fax the signed request to the DuPage County Health Department, Attention: Medical Records
  • Clients 12 to 17 years of age must sign in addition to the Parent or legal representative. *Behavioral Health Only

What we will provide to the you at no cost:

  • The DuPage County Health Department will provide one copy of an abstract* at no cost to you. Additional records requested outside of the abstract* will be assessed a reasonable copy fee.
  • Records sent to another physician or medical provider will be sent free of charge
  • Immunization records, Dental records and Tuberculosis records will be provided free of charge.

 

What is an abstract?

An abstract is a summary of documents related to your care/treatment.  The abstract includes documents completed within the last year or the last document that was completed if the date is longer than 1 year.  Documents in the abstract include Discharge Summary, Mental Health Assessment, Individual Treatment Plan, Psychiatric Evaluation and Psychiatric Progress Notes.   Records not contained in the abstract will be assessed a reasonable copy fee.   Fees for records outside of the abstract are outlined below.

 

2018 Copy Fees

Handling/Processing Fee*

$25

Copy pages 1 through 25

$1.05 per page

Copy pages 26 through 50

$.70 per page

Copy pages in excess of 50

$.35 per page

Postage

Based on weight

Copies made on CD

$2.00

*Assessed when records are retrieved from storage.

 

How to Revoke your Authorization to Release of Information

You have the right to take back (revoke) your authorization to release information.  To do this, you must put your request in wiring and mail it to:

                DuPage County Health Department

                Attention: Medical Records

                111 N. County Farm Road

                Wheaton, IL 60187

 

This request will not apply to any disclosures:

  • Already made when the release of information was in place
  • Made for the purposes allowed by HIPAA (Health Insurance Portability and Accountability Act) and the Illinois Mental Health Developmental Disabilities Confidentiality Act; or
  • Made as required by law

Revocation of Release Form - (English)

Revocation of Release Form - (Spanish)