Memorial Counseling Associates | (217) 788-4065
Providing assessment and therapy services in Central Illinois - Springfield, Lincoln and Jacksonville
Medical Records
MCA's support staff is responsible to fulfill all medical record requests for medical information. It is our policy to charge a nominal fee for all copies, except those sent from MCA to another social service agency or health care facility (doctor's office or hospital).
To request medical records be released, a Consent for Release of Information form needs to be thoroughly completed, signed by the client and returned to MCA's support staff at the site where services are received. The completed form can be returned either in person, by mail or fax (see below). A return telephone number must be included in order to verify the request. If a person elects to pick up records, identification (driver's license or photo ID) will be required. Hours for medical records pick up are Monday through Friday, 8:00 a.m. to 4:30 p.m. Most requests will be processed within two weeks. If a request is needed sooner than that, be sure to make note of that on the paperwork.
MCA's Release of Information form is available to download. You will need Adobe Acrobat Reader installed in order to read the downloaded file.
Consent for Release of Information
If you would like to request a printed copy of MCA's Consent for Release of Information form, please content the site where you receive services.