You can access portions of your child's electronic medical record by signing up for Lurie Children's MyChart.
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
Formulario de autorización de entrega de información sobre la salud
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.
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.
Fax
312.227.9733
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
Required Patient Information
Required Recipient Information
Date(s) Requested
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.
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.
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.
MyChart gives you safe, secure online access to portions of your child's electronic medical record (EMR). MyChart allows you to:
Access medical records safely
Use the secure message center to:
MyChart is not meant to replace the advice given to you by your pediatrician or family practitioner, and should not be used to diagnose a health-related problem or to substitute for medical care.
If your child is having an emergency, call 911. If you think your child may need to be seen, call your child's doctor or 1.800.543.7362 (1.800.KIDS DOC).
Get more information on when to call an ambulance.
A patient must be age 18 or older to become a MyChart account holder. Parents or guardians of children under 18 years of age may become an account holder via a request for proxy access to their child’s account by completing the online registration and submitting an authorization form if required.
Minor patients between the ages of 12 and 17 years (inclusive) are not eligible to become a MyChart account holder, but must provide consent for their parents’ or guardian’s proxy access to their medical information.
Once a minor patient reaches age 18, MyChart access to the proxy account holder will be automatically revoked, and the patient may set up their own account. If the patient is 18 years of age or older and wishes for a parent or guardian to become, or remain, a proxy account holder, the patient and the proxy must complete an authorization form.
