Patients and Visitors at Alexian Brothers Behavioral Health Hospital

Health Information Record

Copy fees are required for obtaining your Protected Health Information from Alexian Brothers Behavioral Health Hospital. Fees are:

• $.86 per page (1-25 pages)
• $.57 per page (26-50 pages)
• $.29 per page (51 or more pages)

• $1.15 per page for microfilm/microfiche

You may mail your completed authorization form to Alexian Brothers Behavioral Health Hospital, Attention: Medical Records Department, 1650 Moon Lake Blvd., Hoffman Estates, IL 60169, or fax it back to our Health Information Management staff at 847-755-8025. If you wish to pick up your records, we will call you when they are ready. Photo identification is required before we can release your records. We can also mail your records to you if it is specified that you wish to have them mailed.

Authorization Form - English

Authorization Form - Spanish