Medical Record Requests

We want to make it as easy as possible for you to get a copy of your medical record. There are several options below to make the process convenient. Please note that in compliance with state and federal laws, all requests must be submitted in writing, completely filled out, and signed.

How to request your medical record

On the form, you will indicate which records to be released (Lab, X-ray, ER, etc.) and how we should release the records--if you will pick up the records or if you would like us to mail them to you or your doctor. Please allow 7-10 days for requests to be processed.

Submit the Form

The completed and signed form may be mailed, faxed, or delivered to:

Pinckneyville Community Hospital
Attn:  Health Information Management
5383 State Route 154
Pinckneyville, IL  62274

Fax: 618-357-6247