Print a request form here: Release of Information Authorization form.

This form is used for requesting a copy of your health information for your own use or for transferring of records. Instructions to complete the form will print with the release form or give us a call. Thorough completion of the form will expedite the record request process.

Completed forms may be sent via mail or fax to the contact information below. If you desire to send a form to us via email, please contact us for further instructions.

Once we receive the request form, staff will review the request and start the process to complete. Our general turnaround time is less than 5 business days, but some requests for records may take up to 30 days to process, in accordance with state allowances. Patients may be charged a flat fee of $6.50 for records requests in the following circumstances:

  • Requesting a complete medical record that includes more documentation than just an abstract of hospitalizations within the last 6 months and is not for continuing care will be charged a flat fee of $6.50.
  • Requesting older than 6 months, abstract or complete, that are not part of continuing care, will be charged a flat fee of $6.50.

Transferring to Another Provider 

Records can be faxed or mailed to provider of your choice. Please let us know your appointment date so we can arrange for records to be delivered timely.

Needing Records for Personal Use?

We offer several options to deliver your medical records, including:

  • Secure Email (our fastest option)
  • Fax
  • Mail
  • On-campus pickup

We will notify you when records have been sent or are ready for pickup.

Records are also available via our online Patient Portal

If you are not already a member of our Patient Portal program, sign up today by calling our office at the extension below or by going here for more information.

Contact Us

  • Via Phone:      217-223-8400 ext. 6600
  • Via Email:       Please call us to make arrangements
  • Via Fax:          217-214-5890
  • Via Mail:         Attn: Health Information Management 
                           PO Box 7005
                           Quincy, IL 62305-7005

Our office is available from Monday-Friday, 8:00 a.m.-4:30 p.m. Pickup locations are available at the Cashier’s Office at 11th St Blessing Hospital campus in Quincy, the Cashier’s office at Blessing Physician Services, Suite 106, and Illini Community Hospital in Pittsfield.