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Health Information Release Form - Hillsboro Health

Protecting Your Health Information

Disclosure of Health Information

At Hillsboro Health, we protect your health information. An Authorization for Disclosure of Health Information Form, also known as a Medical Records Release Form or a Health Information Release Form, is a legal document that allows patients to be in control of who can access their protected health information (PHI). 

Requesting Records

Requesting records from Hillsboro Health is easy. Simply download the "Disclosure of Health Information Form" below, complete it in its entirety and return it to the Medical Records Office at Hillsboro Health. 

The completed form may be returned in the following ways:

  • Mail: ATTN: Medical Records, 1200 E. Tremont Street, Hillsboro, IL 62049
  • Fax: ATTN: Medical Records 217.532.2726
  • Hand deliver to the front desk of Hillsboro Health
Download the Disclosure of Health Information Form

Who needs to complete a Disclosure of Health Information Form

  • Patients who would like a copy of their own health records
  • Patients releasing health records to someone else

Questions? Please contact us!

If you have questions regarding the Health Information Release Form, please contact our Health Information Management Department at 217.532.4463.

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