Patient Information

Patient Information

At Memorial, 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.
  • 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.

Once you complete the form(s), you may fax it to Memorial's Health Information Management department at (618) 257-5319, or you may return to: 

Memorial Hospital
Attn: Health Information Management
4500 Memorial Drive
Belleville, IL 62226