Medical Records

Obtaining Medical Records

How do I request medical records?

In order to protect the privacy of our patients, we require written authorization to release your child’s medical record. You must complete a Medical Records Request Form. You may find a submittable form on our website in the online form section under the forms tab. You may also print the form found under the new patient forms tab, and either fax it to (773) 472-7395 or email to Requests will not be fulfilled if the forms are not completed and signed.

Who should sign the form?

  • If the patient is over 12 years old, the patient must sign for the release of any information regarding mental health, HIV/AIDS, drug and alcohol, sexually transmitted disease, and pregnancy and/or birth control. The patient should sign the form within the box that asks for the patient signature if this information is to be released. The parent or legal guardian must still sign the form of a minor to authorize the release. 
  • If the patient is over 18 years old, the patient must initiate and authorize the request with their signature. A form with a parent signature for a patient over 18 years old will be returned and the request will not be fulfilled. 

How long will it take?

The medical records request may take up to 30 days to fulfill. Please call if you have any concerns regarding the timeline.

How can I receive the records?

You may request that the record be sent by fax, email, or via mail (either a paper or electronic copy on CD).

How much does it cost?

If medical records are being requested for personal use, or to switch practices:
  • The fee is $6.50 for an electronic copy of the record to be sent by CD or email for a child born after April 2012. If you would like to request a paper copy of their chart, the fee is $25.00
  • If your child has was seen at the practice before April 2012, the fee is $25.00.

How do I send outside records to my Lakeview Pediatrics doctor?

You may fill out this Medical Records Request Form and provide the form to your old physician. Your old physician will then communicate with you on how to complete your request.