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 Locations in Pekin, East Peoria, Eureka and Lincoln

Mail or fax your records request to: 

Addiction Recovery Center at Carle Health Proctor Hospital 

Mail your records request to:

Carle Health Methodist Hospital and Carle Health Proctor Hospital Behavioral Health Services  

Mail your records request to: 

Frequently Asked Questions

• How long are records maintained?

  • Records may be retained for a minimum of 10 years, in some cases longer.

• How do I get a copy of my birth certificate or a death certificate of a loved one?

  • All Birth/Death Certificates must be requested through the County Courthouse.

• Is there a charge for obtaining records?

  • There may be costs associated with certain types of requests.

• Do I have to include the patient’s name and date of birth on the form?

  • Yes, this information helps Carle Health team members identify the correct patient.

• Why do I have to include the purpose for the release of my information?

  • Federal law requires the form to include this information.

• What happens if I do not include an expiration date?

  • The release will be valid for one year from the date you signed.

• Does a minor child have to sign the authorization to release their information?

  • 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. 

Very Important 

Questions