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  • Rush Release Form

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Place Patient Label INSTRUCTIONS: As a patient, you have the right to access information in your medical record and to make requests related to this information. The patient rights available to you are listed below please check which of these rights you would like to use. (Note: If a personal representative is making this request, please attach certifying documentation of your status as the personal representative, such as a Power of Attorney or Guardianshi.

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Request Medical Records Download a form authorizing Rush SurgiCenter to release your health information. Fill out the information on the form, indicating the records you are requesting and the specific date of your visit. Sign the form and send it to the address below or to rscmedicalrecords@rushsurgicenter.org.

Request Medical Records Download a form authorizing Rush SurgiCenter to release your health information. Fill out the information on the form, indicating the records you are requesting and the specific date of your visit. Sign the form and send it to the address below or to rscmedicalrecords@rushsurgicenter.org.

Appointments and medical records MyChart: For online prescription refills, test results and appointment scheduling for current patients, call (312) 563-6600 or log in to your MyChart account. Medical records: To request copies of your medical records, please call (312) 942-7262.

If you are a physician or hospital and your request is urgent, please fax your request to 310-206-4831.

Please contact the Medical Records Department with any questions. Address: Medical Records Department, 520 S. Maple Ave., Oak Park, IL 60304. Office phone number: (708) 660-4000. Record request phone number: (312) 942-7262. Monday through Friday: 7:30 a.m. to 4 p.m.

Please address questions about this form to: Rush University Medical Center, ATTN: Health Information Management Office, 1611 West Harrison Street, L1, Suite 001, Chicago, IL 60612, Telephone: (312) 942-7262, Fax: (312) 942-2264.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232