Please forward the request via fax to 708-966-5335 or via email at firstname.lastname@example.org. Please ensure that following information is included on the request:
How to Request Your Records
- Patient name
- Patient date of birth
- Patient future appointment date, if applicable
- Specific records requested
- Completed patient Release of Information (ROI) Form if not a mutual patient
There are 2 options for medical records requests:
1. Visit our Patient Portal HERE and send us a Message!
- Click on Messages
- Choose Compose New
- Change “Message Type” to “Patient Question – Medical Records Request”
- Enter a subject and message
- When ready, click Submit.
2. Complete a Release of Information (ROI) Form and fax to 708-966-5335
Medical Records Release Policy
In order to best prepare for your visit please:
- All medical records to be released from Associates in Sleep Medicine, LLC or Sigma Health, SC require an executed “Records Release” form or an authorization letter signed by the patient, their power of attorney, or other authorized representative.
- Only those records specifically requested may be released.
- There is a fee applied to both the electronic and paper records. Pre-payment is required before records are released.
- $30.00 – Patient
- $35.00 – Attorney Office
- $40.00 – International
- Records will be provided within thirty (30) days as required by law. A special handling fee of an additional $10.00 will be charged if the records must be delivered to the patient or authorized representative within forty-eight (48) hours of the request.