At Memorial Hospital Belleville, we want you to have all the resources you need to manage your healthcare.
We offer tools and assistance to do just that, including:
- MyMemorial Patient Portal—Provides a secure and convenient way to keep your health records online and in one place.
- Patient Authorization Form—Ensures the right people can access your healthcare information.
- Non-Discrimination Information—Provides free aids and services to people with disabilities, and provides free language services to people whose primary language is not English to help patients communicate effectively.
- Privacy Practices—Describes how, when and why we may use or disclose your heath information, as well as your rights with regard to your health information.
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.