Are you a Riverside MyChart user?
You can request and receive medical record copies through your MyChart account at no charge.
- Log into your MyChart account.
- Click the “Health” icon (file folder with a small red heart) near the top left of the Home page.
- Select “Request Medical Records” from the Medical Tools section
- Complete all required fields on the “MyChart Request to Release Medical Records”
- Click the [Continue] button at the bottom of the screen
- Review the next screen, if changes are needed
1. Click the small pencil at the far right of any section you’d like to change
2. Make necessary changes
3. Click the [Jump to Review] button at the bottom of the screen - Click the [Submit] button at the bottom of the screen
Medical record copies will be sent to your Riverside MyChart account.
Not a MyChart user?
Consent to Release Medical Records needs to be completed to begin this process. Please complete the form and return it as instructed below. Alternatively, you may stop by the Release of Information office in the Schneider Outpatient Center on the Pavilion’s first floor on the hospital campus, Monday - Friday, 8:00 am - 4:30 pm. Please allow a minimum of seven days turnaround for copies once we receive the completed consent form.
Download Consent to Release Form
Instructions for Completion of Consent to Release Medical Records
PLEASE LEGIBLY PRINT ALL INFORMATION YOU ENTER ON THE FORM (except signature)
- Enter the name, birth date, and last four digits of the social security number of the patient for whom you are requesting medical records in Section “A” to ensure that we search for the correct patient
- Enter the name of the person who is authorizing the release of these records (the person who will be signing the consent form) on the line marked “B”
- Enter complete mailing information for the individual to whom medical record copies should be sent in Section “C”
- Enter the date range for which you request medical records on the line marked “D”; Riverside Medical Center follows a ten-year retention schedule for medical records. Records from CY 2007 to the present should be available
- Mark the box(es) of the document(s) you are requesting in Section “E”; if the selections listed do not meet your needs, mark “Other” and clearly describe the documents you are seeking
- Enter the reason you’re requesting medical records on Line “F”
- Sign and date the form on Line "G"
- If you are not the patient, complete Line "H"
- Return the completed form to:
Riverside Medical Center
Health Information Management Department
ATTN: Release of Information Area
350 N. Wall Street
Kankakee, IL 60901Or Fax the form to (815) 935-7862
Copies sent directly to another healthcare provider (hospital, clinic, physician) are free of charge.
Medical record copy fees for patients:
Pages 1 – 25 $ 0.75 per page
Pages 26 – 50 $ 0.50 per page
Pages 51 and higher $ 0.25 per page
Medical record copy fees for all others (e.g., attorneys, insurance companies):
Handling & processing fee: $33.60(must accompany the copy request)
Pages 1 – 25 $ 1.26 per page
Pages 26 – 50 $ 0.84 per page
Pages 51 and higher $ 0.42 per page
Electronic format (on CD): pricing is half of what is listed above - please indicate on the consent form if you’d like your record copies on
CD Postage & shipping Actual cost if mailed/shipped
Payment is required when the copies are picked up in theRelease of Information Office. If copies are being mailed, record copies totaling $10.00 or less will be mailed with a bill for this service. An invoice will be mailed to you before we mail the copies if record duplication fees total more than $10.00, and the copies will be mailed once payment is received. Please get in touch with our Release of Information Center at (815) 935-7256 Ext: 38304 if you have any other questions or would like to discuss this process with our service representative.
Thank you for choosing Riverside!
