A PART OF THE MEMORIAL
Hospitals
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    With a team dedicated to your health and the latest in medical technology, we are setting the standards in high-quality healthcare.

    MemHosp.com
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    Coming in 2016! This 94-bed hospital will have private patient suites, ICU, cardiac cath lab, surgical suites, and an obstetrics unit.

    MemHospEast.com
Doctors

Memorial Medical Group is a physician-directed, community-wide organization, committed to improving the health of its patients.

For a full listing of all members of Memorial’s Medical Staff, click here

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Memorial Careers
Foundation

Memorial Foundation raises funds and enhances community support to assist Memorial in providing providing exceptional healthcare.

Memorial Gift
Careers

Memorial offers employment in a patient-centered environment where dedicated staff work together to serve our communities.

View a full listing of Careers at Memorial.

Memorial Careers

Memorial Hospital

Patient Authorization Form

Patient Authorization Form

Protecting your health information

The Privacy Standards of the Health Insurance Portability and Accountability Act (HIPAA) include specific requirements for the content of an authorization for disclosure of protected health information.

To assure authorizations comply with HIPAA requirements, Memorial requires the patient to complete Memorial's Authorization Form when authorizing disclosure of protected health information to a third party for non-treatment related purposes. Memorial provides a Patient Authorization Form on its web site to give requestors easy access to this form. This form can be downloaded, completed by the patient, and then directed to the appropriate department at Memorial for processing.

Memorial Hospital

4500 Memorial Drive
Belleville, Illinois 62226
(618) 233-7750

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