Patient Records
For the convenience of our current and former patients, we are pleased to provide the ability to download authorization forms to request your medical records.
To Request Medical Records
Please submit a signed copy of an authorization to release your protected health information.
- Identify the most appropriate form below based on the information you wish to be released.
- Download and print the appropriate form.
- Complete all required fields, sign, date, and mail or fax the form to the location where your healthcare services were received.
- Please note that releases involving mental health and/or addiction recovery services require you to have a witness signature to be processed.
Locations to Request Medical Records
Trillium Place Locations in Peoria
Mail or fax your records request to:
Trillium Place on Jefferson
Attn: Records Department
228 NE Jefferson Ave., Peoria, IL 61603-3802
Phone: (309) 671-8000
Fax: (309) 671-8059
Trillium Place Locations in Pekin, East Peoria, Eureka and Lincoln
Mail or fax your records request to:
Trillium Place Pekin
Attn: Records Department
3248 Vandever Ave. Ste A ., Pekin, IL 61554
Phone: (309) 477-5530
Fax: (309) 477-5593
Addiction Recovery Center at Carle Health Proctor Hospital
Mail your records request to:
Addiction Recovery Center at Carle Health Proctor Hospital
Attn: Records Request
5409 N. Knoxvillve Ave., Peorial IL 61614
Phone: (309) 691-1055
Carle Health Methodist Hospital and Carle Health Proctor Hospital Behavioral Health Services
Mail your records request to:
Carle Health Proctor Hospital
Attn: Health Information Management
5409 N. Knoxville Ave., Peoria, IL 61614
Phone: (309) 691-1047
Frequently Asked Questions
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How long are records maintained?
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Records may be retained for a minimum of 10 years, in some cases longer.
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How do I get a copy of my birth certificate or a death certificate of a loved one?
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All Birth/Death Certificates must be requested through the County Courthouse.
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Is there a charge for obtaining records?
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There may be costs associated with certain types of requests.
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Do I have to include the patient’s name and date of birth on the form?
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Yes, this information helps Carle Health team members identify the correct patient.
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Why do I have to include the purpose for the release of my information?
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Federal law requires the form to include this information.
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What happens if I do not include an expiration date?
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The release will be valid for one year from the date you signed.
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Does a minor child have to sign the authorization to release their information?
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In some cases, a minor child under the age of 18 years old may be required to authorize the release of their records. For mental health and addiction recovery records, minors, aged 12-17 years, are required to sign a request to release their records in addition to their legal guardian.
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Very Important
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Authorizations will expire one year from the date signed unless otherwise specified.
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Mental health or addiction recovery records may require special authorizations, signatures or releases.
Questions
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Please call the Health Information Department at (309) 691-1047 if you have questions about completing the forms or obtaining copies of your medical records.
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For information on general medical records, please call the Health Information Department at (217) 902-6500 or visit carle.org.
Experiencing a Crisis?
For life-threatening concerns, call 911 or be taken to your nearest emergency department.
For mental health and substance use crisis support and resources, contact:
Trillium Place Crisis Services, available 24/7:
Peoria County - (309) 671-8084
Tazewell & Woodford Counties - (309) 347-1148