Request Medical Records

All medical record requests will be processed by our release of information vendor partner Midwest ROI.

Option 1: In Person– You may visit the Health Information Management Department between the 8am to 4pm. Please arrive no later than 15 minutes before closing time and bring a valid, government issued photo ID. You may enter South Shore Hospital from the main entrance at 80th and Crandon Avenue. Please stop at the security desk for directions to the department.

Option 2: Via Mail– You may fill out a downloaded copy of the authorization form below. Please complete the form legibly, sign your signature neatly on the form and send it in along with a legible copy of a government issued photo ID. Please mail your completed documents to:

South Shore Hospital
Attn: Health Information Department
8012 S. Crandon Avenue
Chicago, Il 60617

Option 3: Via Fax– You may fax a completed, legible authorization for release form along with a clear copy of your government issued photo ID to 773-356-5155. This option is for patients only. Legal requests must be mailed to the address above.

Please download the authorization form below:
Authorization for Release of Information form and follow the guidelines for completion.

Guidelines for completing the authorization for release form:

To avoid a delay in fulfilling your request, a valid authorization MUST include the following information:

• Patient’s full name (Please list any other names, suffixes or middle initial (e.g. maiden name or Jr.) used at the time of admission or treatment.
• Patient’s date of birth.
• Patient’s full address and phone number
• Date(s) of treatment or services requested.
• Reason for your request.
• Name of the person, facility or provider the information is to be released to.
• Select the method of release. (We will fax to another hospital or physician office, but we will not fax to a home or business).
• Specify the information requested.
• Patient’s signature or patient’s legal representative’s signature. (Authorizations signed by a patient representative must have accompanying documentation. Records will not be released without valid signature(s)/ or documentation (if applicable).

Who is authorized to sign for release?

A valid signature includes:

• The patient, if they are 18 years or older.
• The parent or legal guardian, if the patient is younger than 18 years of age, with the exception of highly confidential information, such as mental health records, records containing HIV/AIDS, drug and alcohol, sexually transmitted disease, pregnancy and/or birth control information. State law requires patients 12 and older to authorize the release of this highly confidential information.
• A guardian, if the patient has been legally deemed incompetent. Documentation must be provided to prove guardianship.
• Emancipated minors. Documentation required.
• In the event the patient is unable to sign, documentation of Power of Attorney for Healthcare is required.
• Requests for medical records of deceased patients require a copy of the death certificate, evidence of next of kin, or evidence of executorship of the estate or administrator of the estate. Please contact Midwest ROI for more information at 312-243-9828

Is there a copying fee for medical records?

FEES FOR MEDICAL RECORDS:

Requests for personal use:

• There is a fee for the copying and processing of records for personal use. Please see the fee schedule fee schedule.
• Please allow a reasonable amount of time to process your request. Typically, requests are processed within 7-10 business days. A Midwest ROI representative will contact if there are any barriers to processing your request.
• Records will be mailed to the address specified by you on the authorization form. You may also decide to pick up your records in person. Please call the Release of Information staff at 773-356-5246 before visiting our office. For security reasons, you will be asked to provide a state or federally issued photo ID. We will not release records to individuals who are NOT the patient. Please call 773-356-5246 if you have questions about special circumstances.

Requests for continuity of medical care:

* Complete the authorization for release request form provided by your health care provider’s office. They can fax your signed authorization form to 773-356-5155. There is NO charge for this service.

• Alternatively, you can download, complete and submit the Authorization for Release of Information form in person at our office. You will need the healthcare provider’s address, phone number and fax number, along with your valid government issued ID.
• Medical emergencies will be faxed upon confirmation of patient’s presence at another health care facility (i.e. Face Sheet).
• Continuing care requests are FREE of charge and will be mailed or faxed to your health care provider prior to your appointment. Please indicate the date of your appointment to allow for time to process your request.
• Pertinent information such as radiology/imaging, history and physical, consultations, operative reports, discharge summaries, laboratory results, and ER reports are routinely provided to the physician for continuation of care.

How much will it cost?

The cost is determined per page and dependent on the purpose for which the record is requested:

• There is NO charge for information to be sent from our facility directly to another hospital or physician (continued medical care).
• Patients/requestors (personal use) will be charged a per page fee for copies according to the State of Illinois fee schedule. The handling fee does not apply to patients or continuity of care requests.
• To reduce the cost you, you may request an “Abstract” or have your provider request the record on your behalf.

Where do I deliver, mail or fax the authorization form?

Please mail the completed authorization form and a copy of your government issued ID to:

South Shore Hospital
Attn: Health Information Management Department
8012 S. Crandon Avenue
Chicago, IL 60617

OR

Please fax the completed authorization form and a copy of your government issued ID to:

773-356-5155

OR

Arrive in person along with a government issued ID between the hours of 8am and 3:45pm at:

South Shore Hospital
Attn: Health Information Management Department
8012 S. Crandon Avenue
Chicago, IL 60617

How can I obtain the status of my request?

Please contact our release of information partners at MIDWEST ROI by calling 312-243-9828.

What if the information is highly confidential?

Requests of highly confidential information, such as mental health records, records containing HIV/AIDS, drug and alcohol, sexually transmitted disease, pregnancy and/or birth control information, please pay special attention to the “Information to be Disclosed” section of the authorization form. Be sure to check the applicable boxes for any information you do NOT want released.

You may exercise your right to pick up such highly confidential portions of your medical records in person.

Per State law, a patient 12 years of age and older with medical records containing highly confidential information, such as mental health records, records containing HIV/AIDS, drug and alcohol, sexually transmitted disease, pregnancy and/or birth control information are required to sign the authorization to release form. The parent or legal guardian, will NOT be able to sign the release of information authorization form on behalf of their child.

How can I get a birth or death certificate?

South Shore Hospital does not issue or keep copies of birth certificates or death certificates. To obtain a copy of a birth certificate or a death certificate you will need to visit the Illinois State Vital Statistics Bureau at online: https://www.cookcountyclerk.com/agency/vital-records

OR

Cook County Clerk’s Office

Cook County Clerk
69 W. Washington, Suite 500
Chicago, IL 60602

How do I receive a copy of my DIAGNOSTIC IMAGES?

REQUEST FOR DIAGNOSTIC IMAGES:

Contact the Radiology Department directly at (773) 356-5325, 5326, 5327, or 5328. You may speak with anyone in the department and provide the following information:

• Patient’s full name (Please list any other names, suffixes or middle initial (e.g. maiden name or Jr.) used at the time of admission or treatment.
• Patient’s date of birth.
• Patient’s full address and phone number
• Date(s) of treatment or services requested.
• Reason for your request.

Please allow a reasonable amount of time to process requests, typically 5-10 business days. Radiology will make your CD and have it ready when you come in with the required fee. Please see the attached DIAGNOSTIC IMAGES FEES (PDF)

Experienced Doctors

Complete primary care services, from routine check-ups and preventive care at five affiliated neighborhood clinics and affiliated physicians.

Friendly Staff

Excellent and personable physicians, nurses, and professional staff. Transportation Services for seniors and disabled patients at affiliated clinics and the hospital.

ARE YOU LOOKING FOR A

Health Care Provider?

Search our list of health care providers and find the specialist that you need.

(773) 356-5000

• (773) 356-5000
• 8012 South Crandon Ave. Chicago, IL 60617

Accessibility

Accessibility modes

This mode enables people with epilepsy to use the website safely by eliminating the risk of seizures that result from flashing or blinking animations and risky color combinations.

This mode adjusts the website for the convenience of users with visual impairments such as Degrading Eyesight, Tunnel Vision, Cataract, Glaucoma, and others.

This mode provides different assistive options to help users with cognitive impairments such as Dyslexia, Autism, CVA, and others, to focus on the essential elements of the website more easily.

This mode helps users with ADHD and Neurodevelopmental disorders to read, browse, and focus on the main website elements more easily while significantly reducing distractions.

This mode configures the website to be compatible with screen-readers such as JAWS, NVDA, VoiceOver, and TalkBack. A screen-reader is software for blind users that is installed on a computer and smartphone, and websites must be compatible with it.

Online Dictionary

Readable Experience

Visually Pleasing Experience

Easy Orientation

South Shore Hospital Accessibility Statement

Accessibility Statement

• www.southshorehospital.com
• September 3, 2024

Compliance status

We firmly believe that the internet should be available and accessible to anyone, and are committed to providing a website that is accessible to the widest possible audience, regardless of circumstance and ability.

To fulfill this, we aim to adhere as strictly as possible to the World Wide Web Consortium’s (W3C) Web Content Accessibility Guidelines 2.1 (WCAG 2.1) at the AA level. These guidelines explain how to make web content accessible to people with a wide array of disabilities. Complying with those guidelines helps us ensure that the website is accessible to all people: blind people, people with motor impairments, visual impairment, cognitive disabilities, and more.

This website utilizes various technologies that are meant to make it as accessible as possible at all times. We utilize an accessibility interface that allows persons with specific disabilities to adjust the website’s UI (user interface) and design it to their personal needs.

Additionally, the website utilizes an AI-based application that runs in the background and optimizes its accessibility level constantly. This application remediates the website’s HTML, adapts Its functionality and behavior for screen-readers used by the blind users, and for keyboard functions used by individuals with motor impairments.

If you’ve found a malfunction or have ideas for improvement, we’ll be happy to hear from you. You can reach out to the website’s operators by using the following email tdanderson@sshcorp.org

Screen-reader and keyboard navigation

Our website implements the ARIA attributes (Accessible Rich Internet Applications) technique, alongside various different behavioral changes, to ensure blind users visiting with screen-readers are able to read, comprehend, and enjoy the website’s functions. As soon as a user with a screen-reader enters your site, they immediately receive a prompt to enter the Screen-Reader Profile so they can browse and operate your site effectively. Here’s how our website covers some of the most important screen-reader requirements, alongside console screenshots of code examples:

1. Screen-reader optimization: we run a background process that learns the website’s components from top to bottom, to ensure ongoing compliance even when updating the website. In this process, we provide screen-readers with meaningful data using the ARIA set of attributes. For example, we provide accurate form labels; descriptions for actionable icons (social media icons, search icons, cart icons, etc.); validation guidance for form inputs; element roles such as buttons, menus, modal dialogues (popups), and others. Additionally, the background process scans all of the website’s images and provides an accurate and meaningful image-object-recognition-based description as an ALT (alternate text) tag for images that are not described. It will also extract texts that are embedded within the image, using an OCR (optical character recognition) technology. To turn on screen-reader adjustments at any time, users need only to press the Alt+1 keyboard combination. Screen-reader users also get automatic announcements to turn the Screen-reader mode on as soon as they enter the website. These adjustments are compatible with all popular screen readers, including JAWS and NVDA.
2. Keyboard navigation optimization: The background process also adjusts the website’s HTML, and adds various behaviors using JavaScript code to make the website operable by the keyboard. This includes the ability to navigate the website using the Tab and Shift+Tab keys, operate dropdowns with the arrow keys, close them with Esc, trigger buttons and links using the Enter key, navigate between radio and checkbox elements using the arrow keys, and fill them in with the Spacebar or Enter key.Additionally, keyboard users will find quick-navigation and content-skip menus, available at any time by clicking Alt+1, or as the first elements of the site while navigating with the keyboard. The background process also handles triggered popups by moving the keyboard focus towards them as soon as they appear, and not allow the focus drift outside of it. Users can also use shortcuts such as “M” (menus), “H” (headings), “F” (forms), “B” (buttons), and “G” (graphics) to jump to specific elements.

Disability profiles supported in our website

• Epilepsy Safe Mode: this profile enables people with epilepsy to use the website safely by eliminating the risk of seizures that result from flashing or blinking animations and risky color combinations.
• Visually Impaired Mode: this mode adjusts the website for the convenience of users with visual impairments such as Degrading Eyesight, Tunnel Vision, Cataract, Glaucoma, and others.
• Cognitive Disability Mode: this mode provides different assistive options to help users with cognitive impairments such as Dyslexia, Autism, CVA, and others, to focus on the essential elements of the website more easily.
• ADHD Friendly Mode: this mode helps users with ADHD and Neurodevelopmental disorders to read, browse, and focus on the main website elements more easily while significantly reducing distractions.
• Blindness Mode: this mode configures the website to be compatible with screen-readers such as JAWS, NVDA, VoiceOver, and TalkBack. A screen-reader is software for blind users that is installed on a computer and smartphone, and websites must be compatible with it.
• Keyboard Navigation Profile (Motor-Impaired): this profile enables motor-impaired persons to operate the website using the keyboard Tab, Shift+Tab, and the Enter keys. Users can also use shortcuts such as “M” (menus), “H” (headings), “F” (forms), “B” (buttons), and “G” (graphics) to jump to specific elements.

Additional UI, design, and readability adjustments

1. Font adjustments – users, can increase and decrease its size, change its family (type), adjust the spacing, alignment, line height, and more.
2. Color adjustments – users can select various color contrast profiles such as light, dark, inverted, and monochrome. Additionally, users can swap color schemes of titles, texts, and backgrounds, with over 7 different coloring options.
3. Animations – epileptic users can stop all running animations with the click of a button. Animations controlled by the interface include videos, GIFs, and CSS flashing transitions.
4. Content highlighting – users can choose to emphasize important elements such as links and titles. They can also choose to highlight focused or hovered elements only.
5. Audio muting – users with hearing devices may experience headaches or other issues due to automatic audio playing. This option lets users mute the entire website instantly.
6. Cognitive disorders – we utilize a search engine that is linked to Wikipedia and Wiktionary, allowing people with cognitive disorders to decipher meanings of phrases, initials, slang, and others.
7. Additional functions – we provide users the option to change cursor color and size, use a printing mode, enable a virtual keyboard, and many other functions.

Browser and assistive technology compatibility

We aim to support the widest array of browsers and assistive technologies as possible, so our users can choose the best fitting tools for them, with as few limitations as possible. Therefore, we have worked very hard to be able to support all major systems that comprise over 95% of the user market share including Google Chrome, Mozilla Firefox, Apple Safari, Opera and Microsoft Edge, JAWS and NVDA (screen readers), both for Windows and for MAC users.

Notes, comments, and feedback

Despite our very best efforts to allow anybody to adjust the website to their needs, there may still be pages or sections that are not fully accessible, are in the process of becoming accessible, or are lacking an adequate technological solution to make them accessible. Still, we are continually improving our accessibility, adding, updating and improving its options and features, and developing and adopting new technologies. All this is meant to reach the optimal level of accessibility, following technological advancements. For any assistance, please reach out to tdanderson@sshcorp.org