Medical Records

A federal law called the HIPAA Privacy Rule gives you the right to see, get a copy of, and amend your medical record by adding information to it. (HIPAA stands for the "Health Insurance Portability and Accountability Act.")

To request your medical records for any reason, please print out the PDF form below and either fax it to: 312-654-5288, or mail it to:

Obstetric and Gynecologic Specialties of Northwestern, SC
attn: Medical Records
680 N. Lake Shore Dr.
Suite 117
Chicago, IL 60611

You may also email the form to: twedryk@obgynsnw.com.

Please note that there is a $35 fee for requesting medical records.

Please attach a check with your completed form or call 312-654-1166 to process your payment over the phone. Your records will be sent once your payment is received.

medical records release form (pdf format)