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Request for Medical Records

At BJC HealthCare we want you to have all the resources you need to manage your healthcare. We offer tools and assistance including those resources listed below.

When a patient needs a copy of their Alton Memorial Hospital medical record, the Health Information Management department is available to help. The department hours are Monday through Friday 8 a.m. – 4 :30 p.m. Please note a fee may apply.

Individual Request:

To Request Your or Your Child’s Records:

Patients and legal guardians, please click on the link below to request a copy of your medical records.
Individual Authorization Form

Note: Parents and legal guardians, please use this link for your children.

Third Party Request:

To request a copy of your or your child’s records to be sent to a Third Party individual or organization, including your healthcare provider, please complete the Authorization for Release of Information form. Please submit the completed form to the address or fax number listed on the form.

Note: The individual patient (legal guardian for minor patients) whose records are being requested must sign this authorization.

Expired patients:

Records can be released for an expired patient with:

  1. A valid HIPAA compliant request with the following accompanying documentation
  2. Copy of the death certificate (not required if the patient expired at a BJC hospital)
  3. AND one of the following documents:
    1. Documentation verifying the Executor/Representative of the estate of the patient.
    2. Valid, unrevoked Power of Attorney for healthcare decision making which allows the deceased person’s health care records to be released to the agent after death.
    3. Next of Kin Affidavit form

Requesting Records for BJC Medical Group


Birth or Death Certificates may be obtained through Alton City Clerk’s Office, phone number 618-463-3522.

If you have any questions, please contact:

Health Information Management
Phone: 618-463-7395
Fax: 618-463-7193

Right to amend your health information

If you believe there is an error in your records, you can request that we correct them. We will review the information, as requested, and either make the correction or let you know why we think our information is correct.

Please select the appropriate facility and follow the instructions listed on the form. For additional information please call 314-273-2468.

Alton Memorial Hospital

Care Everywhere Revocation Request

Care Everywhere is a tool the BJC Health Care uses to share medical record information with other Care Everywhere health care providers. If you do not want other health care providers to access your BJC medical record information you can revoke your Care Everywhere Opt-in by completing this form. For additional information please call 314-273-2468.

Please fill out the form on this link and send your request to the address listed below.

Health Information Management - BJC Health Care
Attention: Data Integrity
Mailstop 90-59-341
#1 Barnes-Jewish Hospital Plaza
St. Louis, MO 63110


BJC HealthCare and Washington University Physicians MyChart offers patients personalized and secure online access to portions of their medical records. If you have any questions regarding your MyChart account, please log into: https://www.mypatientchart.org or call 314-273-1966 or toll free 866-273-1966.

Find a doctor or make an appointment: 618.463.7220 or 800.392.0936
General Information: 618.463.7311
Alton Memorial Hospital
One Memorial Drive
Alton, Illinois 62002

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