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PATIENTS & VISITORS
Medical/Vital Records
Your Medical Record
The results of all the laboratory tests, x-rays, other diagnostic studies, and medical treatment you have received while you were hospitalized or treated as an outpatient are documented. Also included are physician reports from examinations, surgery, treatment and medications, and observations by nurses and other members of your health care team. This information is combined to make up your medical record.
Swedish American Health System is committed to protecting your privacy and confidentiality. You can obtain medical records and copies of radiology images by printing an authorization form and mailing or faxing it to the proper location. The contact information differs depending on whether you received care in the acute care (hospital) or clinic setting. The Health Information Department located at Camelot Tower maintains patients' health records for both SwedishAmerican Hospital and SwedishAmerican Medical Center Belvidere. SwedishAmerican Medical Group patient records are maintained by each individual site.
Hospital Records
SwedishAmerican Hospital
Health Information Management Department (HIMS)
Camelot Tower
1401 E State St
Rockford, IL 61104
Phone: (815) 489-4540
Fax: (815) 489-4078
Radiology Images Only
SwedishAmerican Hospital
Medical Imaging Department
1401 E State St
Rockford, IL 61104
Phone: (815) 489-4770
Fax: (815) 967-5483
If you are unsure whether your clinic is affiliated with SwedishAmerican, please refer to SwedishAmerican Clinic Listing to find out where to direct your inquiry.
To obtain a copy of your medical records for you or for someone other than yourself:
Records can be released to anyone that a patient authorizes in writing. A valid authorization MUST contain:
- Patient's full legal name, address, phone number and date of birth. (Provide a list of previous names if applicable)
- Provide which facility is authorized to release the information (SwedishAmerican Hospital etc. Specify site if records are from a clinic)
- What information is to be disclosed and the treatment or time period.
- To whom the information is to be disclosed to. (Include name/ facility, address and contact phone)
- The purpose of the disclosure. (Medical care, insurance purposes, other etc)
- Patient's signature or a patient's legal representative's signature. Authorizations signed by a representative must contain a copy of the guardianship papers or power of attorney. Include phone number if we need to contact.
- Witness signature
- Date of the signatures
Requests for medical records of deceased patients require a letter of authority in addition to your signed authorization. The letter of authority is given to the executor of a person's estate by the Probate Court upon their death. Releasing records to anyone other than the executor is illegal. Please also include your phone number in case we need to contact your for additional information concerning your request.
Important Note: A separate authorization is required for each request or site. HIMS does not copy for the Medical Group's medical records. Arrangements will need to be made with each site to have the medical records copied.
Sensitive Information
Certain information requires a special authorization covering sensitive information. This includes psychiatric, drug and/or alcohol abuse, HIV/AIDS, and sexual abuse information. Authorizations for sensitive information must specifically refer to the information that is to be released and include a witness signature. Sensitive information is never faxed, per hospital policy and protection of your privacy
Turnaround Times:
Unless for immediate patient care (acute care facility) allow 21 days for requests to be process. The average processing time is 10 - 14 business days. Incomplete requests can not be processed and will be return to the requestor for completion. Records will be sent through the US Mail. Records needed for medical emergencies will be faxed directly to the physician or medical facility.
Hospital Fees
For continuation of care, pertinent portions of your medical information will be sent directly to your physician/medical facility free of charge. This packet consists of recent discharge summaries, procedure notes, and diagnostic testing results.
All other requests are subject to fees in accordance to IL Law. Some record requested for legal, insurance, or personal use may require a fee approval If your request requires fee approval, a fee notice will be sent to you upon receipt of your request.
If the request does not require a fee approval and there is a charge for your records, you will receive an invoice from SwedishAmerican Hospital including payment instructions. You may also contact the HIMS department for more information about copy fees at (815) 489-4540. Below is the 2013 Fee Schedule for copying of medical records as required under Illinois State Law: 735 ILCS 5/8-2006. There may be an additional fee for postage per federal law.
FEE |
2013 |
| Copy pages 1 through 25 |
$0.97 |
| Copy pages 26 through 50 |
$0.65 |
| Copy pages in excess of 50 |
$0.32 |
| Copies made from microfiche or microfilm |
$1.62 |
Please Note: No payment can be accepted at SwedishAmerican Medical Center Belvidere campus.
Radiology Images
There is no charge for first request to mail radiology images to other hospitals, clinics or physicians for further care and a $20.00 fee thereafter. The following charges apply to copies requested for other reasons:
Digital Radiology Images
Burned to a CD: $20.00 per request
Hard Copy Radiology Images
Charge of $10.00 per sheet of film
Clinic Records
For continuation of care, pertinent portions of your medical information will be sent directly to your physician/medical facility free of charge. This packet consists of recent office visits and diagnostic testing results.
All other requests are subject to fees in accordance to IL Law. Some records requested for legal, insurance, or personal use may require a pre-payment. If your request requires pre-payment, an invoice will be sent to you by HealthPort (the clinic's release of information provider) upon receipt of your request. The invoice will include instructions about how to make payment; HealthPort accepts credit card payments over the phone and internet and check payments over the phone and via mail. If payment is required, the records will be sent after the payment is received.
You may also contact HealthPort directly at (800) 367-1500 for questions about payment or requesting your clinic records. Below is the Fee Schedule for patients for copying of medical records as required under Illinois State Law: 735 ILCS 5/8-2006. There may be an additional fee for postage per federal law.
FEE |
2013 |
| Copy pages 1 through 25 |
$0.97 |
| Copy pages 26 through 50 |
$0.65 |
| Copy pages in excess of 50 |
$0.32 |
| Copies made from microfiche or microfilm |
$1.62 |
Status Calls Release of Information
Please know that we receive a high volume of requests per day and in general, we process these requests in the order in which they are received. Federal and State regulations require healthcare facilities to process requests within 30 days of receipt. We will, however, make every effort to expedite your request.
Please refer all inquires on status of requests for SAH or SAMC-B to SAH 's Release of Information (ROI) Monday - Friday from 8:00 a.m. to 4:30 p.m. to (815) 489-4540. Status calls for clinic records should be directed to specific clinic. Status of the radiology images contact the Medical Imaging Department at (815) 489-4770 Monday thru Friday from 8:00 a.m. to 5:00 p.m.
SwedishAmerican does not provide copies of death or birth certificates. For information about how to obtain a copy of a death or birth certificate, please contact the Winnebago County Health Department at (815) 720-4044.
Thank you, we look forward to assisting you with your medical record needs.
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