Records and Assistance
At Memorial Hospital, we want you to have all the resources you need to manage your healthcare.
We offer tools and assistance to do just that, including:
- Patient Portal - Provides a secure and convenient way to keep your health records online and in one place.
- Non-Discrimination Information - Provides free aids and services to people with disabilities, and provides free language services to people whose primary language is not English to help patients communicate effectively.
- Privacy Practices - Describes how, when and why we may use or disclose your heath information, as well as your rights with regard to your health information.
- Request for Access to Protected Health Information - Please complete this form to have a copy of your medical records sent to you or to someone other than yourself. Note: Parents and guardians, please use this form for your patients.
- Authorization for Release of Information - Third parties, please complete this form to request a copy of an individual’s medical records. Note: The individual whose records are being requested must sign this authorization.
- Centralized Scheduling - Call 618-257-4949 or fax 314-454-4641 to schedule x-rays, diagnostic testing, and other labs and tests.
Once you complete the form(s), you may fax it to Memorial's Health Information Management department at (618) 257-5319, or you may mail to:
Attn: Health Information Management
4500 Memorial Drive
Belleville, IL 62226