Request Medical Records

Cook County Health patients can request a copy of their Medical Records by submitting a Medical Record Authorization Release form either in-person or by mail/fax.

To request a copy of your medical records:

Fill out the Medical Record Authorization Release form, click on the link below to download.

Medical Record Authorization Release – English

Medical Record Authorization Release – Spanish

Medical Record Authorization Release – Polish

Include a copy of a Valid Photo ID (passport, driver’s license, state ID or school ID). Note that a copy of a valid ID is required before processing.

Your request can be mailed/fax or submitted in person at any of the following locations:

John H. Stroger, Jr. Hospital*
1969 W. Ogden Ave., Room 1690
Chicago, IL 60612
Phone: (312) 864-6152
Fax: (312) 864-9890

Provident Hospital
500 E. 51st St., Room 1016
Chicago, IL 60615
Phone: (312) 572-1527
Fax: (312) 572-1524

*All health center records can be obtained here.

Payments & Rates

Once your request is completed, your medical records and a corresponding bill will be mailed to you.

The rates are outlined in the chart below, and y ou can pay by check or online at www.healthportpay.com .

$6.50 flat fee for electronic portion
$1.08 flat fee for a CD or USB for
paper converted to electronic format
Plus $0.07 per page of paper record

To Obtain Vital Records

Copies of birth, death and other official records for Chicago and suburban Cook County residents can be obtained from the Cook County Clerk’s office at www.cookcountyclerk.com or (312) 603-5656.

To Obtain Images

To request images, please contact:

Radiological Images: (312) 864-7070

Mammography Images: (312) 864-3805

Other Departments

To contact other departments, please see the numbers below.

Patient Support Center/Scheduling Options: (312) 864-0200

Billing Records: (866) 223-2817

Patient Referral Support Center, Fax: (312) 864-7039

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The office’s primary responsibilities include:

• Training Employees on the Employment Plan and Supplemental Policies and Procedures Manual. All employees are introduced to the fundamental principles, an overview of the main hiring processes, and to the obligations and protections that apply to all employees.
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  Alice Collins

  

  Community Outreach Worker

  Email: [email protected]

  Phone: 708-293-8217

  A native Chicagoan, Alice fell in love with community outreach when she was only a teen. The youngest of 10 children, she got a job through the City of Chicago Summer Youth Employment program working at a local youth service agency, where she was part of a team reaching out to other teens and encouraging them to avoid unhealthy behaviors. Through that experience, as well as challenges her family faced, Alice developed a deep enthusiasm for sharing resources and information to make a difference in the lives of others.

  Alice was the first in her family to obtain a Master’s Degree and has wide-ranging experience working in the non-profit and healthcare sectors. In her previous job, she helped homeowners experiencing foreclosure to avoid losing their homes. During her time there, Alice uncovered a large-scale fraud operation involving individuals deeding homes in foreclosure to themselves. She diligently followed up with law enforcement, elected officials, and HUD and advocated on behalf of the property owners. After a lengthy investigation, the State’s Attorney’s Office charged and convicted four people with fraud, and the victims were able to secure title to their homes. In response, Cook County changed the way property deeds are recorded, making homeowners less vulnerable to this type of theft.

  At Cook County Health, as part of the Outreach team, Alice helps people connect with our health system and CountyCare so they can access the care they need. A graduate of the CCH Leadership Development Institute, she is devoted to serving our patients and investing in the communities where our clinics are located. She even advocated for sponsorship of a local youth baseball program in the Ford Heights community as a way for youth there to build confidence, be involved in team building and demonstrate Cottage Grove Health Center’s investment in the community.

  Alice is committed to engaging diverse communities and is passionate about sharing Cook County Health’s motto, “We Bring Care to the Community”.

  Kaelin Long

  

  Community Outreach Worker

  Email: kaelin.long@blank

  Phone: 312-572-2154

  As a native of Chicago, Kaelin Long grew a passion for developing connections, addressing substantial health concerns, and advocating for diversity and inclusion in underserved communities. Her love for community became evident through her passionate and persistent work both professionally and in her personal life. Kaelin is dedicated to giving back to the community through public service with non-profit organizations. Her work with the Ronald McDonald House Charities, allows her to provide support, health resources, and a sense of stability for families and children who are receiving medical attention.

  Kaelin obtained a Masters Degree in Public Health from Indiana State University and began her journey into the field of public health and social services. In previous roles, Kaelin worked for Chicago Commons Adult Day Service in the Englewood community and Catholic Charities of the Archdioceses located in Harvey Il. During her time spent with both organizations, Kaelin honed in on improving quality of life, implementing health initiatives, providing senior support services and advocating for seniors diagnosed with Dementia and Alzheimer’s. Her goal has always been to make a difference in the lives of others, while maintaining their dignity and respect.

  Kaelin accepted her role as a Community Outreach Worker with Cook County Health and immediately saw it as an opportunity to engage and build lasting relationships with community members and leaders across the Chicagoland area. She began helping individuals to connect with our health system, County Care, and broaden their knowledge and access to all the services that are available to them. Kaelin is committed to the empowerment, advancement, and acknowledgement of those who make our community feel like home.