Medical Records Requests

Request­ing Med­ical Records

Please note that some of the infor­ma­tion you are request­ing may be avail­able online in our patient por­tal, MyChart.

To have a copy of your med­ical records sent to Duly Health and Care from anoth­er facil­i­ty, please con­tact that provider directly.

Please do not mail or fax med­ical records from oth­er facil­i­ties to our release of infor­ma­tion ven­dor, Verisma.

A request to obtain copies of your med­ical record can be completed:

Online

• Com­plete the Autho­riza­tion for Release of Health Infor­ma­tion Form
• These com­plet­ed forms are auto­mat­i­cal­ly rout­ed to Scan­STAT for completion

By Paper Form

• If you pre­fer to com­plete a paper autho­riza­tion form, please down­load and print the Autho­riza­tion for Release of Health Infor­ma­tion Form (AUTOR­IZACIÓN PARA LA DIVUL­GACIÓN DE INFOR­MA­CIÓN DE SALUD).
• Sub­mit your com­plet­ed paper autho­riza­tion forms to Veris­ma by email­ing a copy to mrrequests@​duly.​com or by fax­ing to (630) 873‑8797.

For ques­tions, please call (630) 873‑8748, Mon­day through Fri­day, 8AM — 5PM.

Deliv­ery

Request­ed records will be mailed to the address spec­i­fied or sent elec­tron­i­cal­ly via encrypt­ed email, secure FTP, or requestor por­tals. Please indi­cate the pre­ferred deliv­ery method in Sec­tion 4 of the Autho­riza­tion for Release of Health Infor­ma­tion Form.

Please allow up to 30 days for processing.

Fees

There are no fees asso­ci­at­ed with requests for infor­ma­tion to be sent direct­ly to anoth­er med­ical provider out­side of Duly Health and Care. There may be fees asso­ci­at­ed for requests to be sent to you or to some­one who is not a med­ical provider. If there is a fee for your request, Veris­ma will pro­vide you with an invoice sum­ma­riz­ing the charges. Pay­ments can be made online https://​www​.scan​stat​.com/​p​a​y​-​i​n​v​oice/, over the phone by call­ing (866) 442‑9026 or by mail­ing a check to the address list­ed on the invoice. Accept­ed forms of pay­ment are check or cred­it card. Cash pay­ments are not accept­ed. All fees are in accor­dance with Illi­nois and fed­er­al law.