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    Medical Records

    Medical Records

    We want to make it as easy as possible for you to get a copy of your medical record. There are several options below to make the process convenient. Please note that in compliance with state and federal laws, all requests must be submitted in writing, completely filled out and signed.


    How to request your Deaconess medical record:

    1. Download and complete the corresponding Medical Information Release Form

    Deaconess Indiana and Kentucky

    On the electronically fillable form, you will indicate how we should release the records - if you will pick up the records or if you would like us to mail them to you or your doctor. Please allow 5-10 days for requests to be processed.

    There will be a nominal charge for copying. It is based on the amount of pages to be copied. However, if records are being sent to another physician, the fee will be waived.


    Deaconess Illinois

    Complete all sections, including:

    1. Patient’s Name, Date of Birth, Address and Phone Number
    2. Facility Authorized to Release Information to:
      1. Records Released to you - write in “SELF"
      2. Records Released to another Provider or Facility - please fill in the Providers name, address, phone and FAX number.
      3. Health Information to be disclosed - include all dates of service, what type of records you want released (labs, x-ray, complete, etc.), why you need the information (treatment, insurance, personal),
    3. The Yes/No question is an authorization to release any sensitive information. Typically this should be marked yes if you require all of your information to be released.
    4. Patient’s or Authorized Personal Representative’s Signature – please sign, date and time.
    5. Leave the Witness Signature line and everything below it blank.


    2. Submit the Form

    Deaconess Indiana and Kentucky

    The completed and signed form may be emailed to Deaconess.MedicalRecords@deaconess.com or mailed, faxed or delivered to Deaconess Midtown Hospital Medical Records Department:

         Deaconess Midtown Hospital

         600 Mary St.

         Evansville, IN  47747

         FAX: 812-450-3995


    Deaconess Illinois 

    Please submit request via fax or email at the following:


    Birth Certificates

    To request a birth certificate, please contact the Vital Records Section of the state or county health department where you were born. The Vanderburgh County Health Department Vital Records Section can be reached at 812-435-2400.

     

    MediCopy (FMLA and Disability)

    MediCopy is a health information management company that has partnered with Deaconess to provide accurate and timely delivery of Disability/FMLA forms. MediCopy is fully HIPAA compliant and adheres to all state and federal regulations regarding your protected health information.


    How to submit your MediCopy form:

    • Download MediCopy Intake form.
    • Deliver your form(s) to your healthcare facility. Your form(s) will then be sent to MediCopy for completion. Please allow one business day before calling to make payment or check status.
    • Forms are $30 for the first form and $15 for each additional form turned in at the same time. MediCopy will send an invoice, forms cannot be completed prior to payment. Please provide an email address if available as this will expedite the process.
    • Once payment is received, MediCopy will complete your form(s) within three business days and sent to the requesting party. Forms will be completed based on information in your chart.
    • If you have any questions, please contact MediCopy at 866-587-6274.


    Contact Deaconess Medical Records

    Deaconess Indiana and Kentucky
    812-450-3618


    Deaconess Illinois

    Deaconess Illinois Crossroads
    618-241-8547

    Deaconess Illinois Medical Center
    618-998-7036

    Deaconess Illinois Union County
    618-833-4511 ext 4221

     

    For questions regarding Medical Records across any Deaconess location, please complete the form below. 

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