Riveredge Hospital fax number

Fax destination details

Department

Health Information Management Department

Purpose

Requesting medical records / Authorization to Use or Disclose Protected Health Information (HIPAA release).

Form

medical records release form — Authorization for Release of Protected Health Information

Address

8311 W Roosevelt Rd, Forest Park, IL 60130

Voice phone

708-771-7000 (Health Information Management, ext. 3160 or 4160)

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Complete the authorization form in full (including patient name, birth date, and contact information). Indicate the recipient of the information, the purpose, and the specific records to be released. For minors, a parent/guardian must sign; for ages 12–17 the patient’s signature is also required. The form must be signed and dated. Processing typically takes 7–10 business days; fees may apply for non-abstract requests. Completed authorizations can be returned to Riveredge Hospital, Health Information Management Department, or faxed to 708-771-8409.

Official form instructions are published as a downloadable file on the organization's website.