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Request for Medical Records

In order to release medical records to a patient or third party, a patient authorization is required.  Please select the appropriate Release of Information form.

**Please note, a fee for the medical record may apply.

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.

Print the appropriate form, complete and mail to:

Alton Memorial Hospital
Health Information Management
ATTN: Release of Information
1 Memorial Dr.
Alton, IL 62002 USA

(These forms are in PDF format and require Adobe Acrobat Reader. If you don't have this software, go to Adobe for a free download.)

If you have questions, call 618.463.7395 or 618.463.7393 between 8 a.m. and 4:30 p.m. Monday through Friday.

Obtaining a Birth Certificate

Birth Certificates may be obtained from the Alton City Clerk’s Office. The address is 101 E. Third St., Alton, IL 62002, phone 618.463.3522. There is a $12 fee for a copy of the birth certificate. Please contact the City Clerk for further information.

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

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