To request your medical records, please print and complete a release form and return to Carle Foundation Hospital.
Completed release forms can be returned to Carle:
Carle Foundation Hospital
Attn: Health Information Management
3310 Fields South Drive
Champaign, IL 61822
The Carle Health Information Management Department is located at Carle at the Fields, near the Stephens Family YMCA and Interstate 57. Use Google Maps for driving directions from your location.
Please call the Health Information Department at (217) 902-6500 if you have questions about completing the forms or obtaining copies of your medical records.
How to complete the Authorization to Release Protected Health Information form}
Patient Identifiers - this section helps us select the correct patient.
Where do the records need to go?
This section tells Carle where to send the records.
Method of Release: How should the copies to be sent?
Carefully read the bulleted paragraphs, so that you know what you are signing. If you have questions, please call (217) 902-6500.
Signature and address: Please read the ATTENTION: section. You'll need to sign and date the form. Enter your address at the bottom.
Mental health records may require special authorizations, signatures or releases. Please call our Health Information Management department at (217) 902-6500 for more information.
The authorization will expire one year from the date signed unless otherwise specified. If you have any questions about completing forms or obtaining copies of medical records, call Health Information Management at (217) 902-6500.