Medical Records Request
To request your medical records to be released from Midwest Medical Center or to Midwest Medical Center, please download and complete the Release of Information Form.
Please mail or fax the completed authorization to:
Midwest Medical Center Attn: HIM Department 1 Medical Center Drive Galena, IL 61036Fax: 815-777-2671
Release of Information Forms
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Release of Information Form - To Facility
Release of Information Form - To Facility -
Release of Information Form - From Facility
Release of Information Form - From Facility -
Release of Information Form - Workman's Comp
Release of Information Form - Workman's Comp