Medical Records

You can access portions of your child's electronic child's medical record by signing up for Lurie Children's MyChart.

Printed Medical Records

You can also request printed medical records by fax, mail or in person. Return the completed form below to Health Information Management. 

Authorization for Release of Patient Information Form

Copies of Medical Records

Please allow approximately 5-7 business days for the processing of all requests. Hours of Operation: Monday-Friday. 8 a.m.-4:30 p.m. You can reach the Health Information Management Office at 312.227.5220.​

Submit your form:

In Person
If you/your child are hospitalized, submit the form upon discharge to Health Information Management, located on the main hospital's 9th floor.

Attn: Release of Information

Ann & Robert H. Lurie Children's Hospital of Chicago
Health Information Management
225 East Chicago Avenue, Box 11
Chicago, IL 60611
Attn: Release of Information

Guidelines for Completing the  Print Form

Required Patient Information
  • Patient's full name
  • Patient's date of birth
  • Address
  • City/State/ZIP
  • Telephone number
Required Recipient Information
  • Leave the “From” area blank unless you are requesting records from another hospital or physician to be sent to Lurie Children's
  • Print the name/institution and address to whom you wish your records to be sent; there is no charge for releasing copies of health information directly to other healthcare providers
Date(s) Requested
  • Specify the date(s) of treatment for which you are requesting records; documents will be copied for the dates of treatment you specify
  • Type of Information Requested
  • Select the category or categories of information you specifically want copied
  • If the record contains any of the highly confidential items listed, they must be checked off specifically in order to be released
  • To reduce your cost, you should consider requesting specific information rather than the complete record (check the “Abstract” box to do this)

Highly Confidential Items

If you would like any of the highly confidential items listed to be included in the release of your records, they must be specifically checked off. Please note the signature requirements listed.

Select or describe the purpose for releasing the information.

Authorization Expiration

Specify the date on which the authorization will expire. If not otherwise specified, it will expire within 30 days of the date of signature, the exception being mental health releases which expire in one year from the date of signature.

If you are the authorized requestor, please sign and date the authorization. Information will not be released without proper signatures.

Supporting Documentation

If your signature cannot be validated, you may be asked to provide supporting documentation that proves your authority to sign the authorization on the behalf of the patient. Please have your signature witnessed.