Patient Information & Privacy

Assisting patients in accessing their personal healthcare information

Welcome to the Compliance Department at Prairie Cardiovascular Consultants (PCC).

The Compliance staff handles external releases of patient information, develops policies regarding education and privacy compliance with applicable laws, and assists patients with privacy issues or concerns.

Requesting a release of information or records

The Compliance Department processes all requests for release of patient information.  To assist patients in accessing their personal healthcare information (hard copies of medical records), patients should thoroughly complete the Prairie Cardiovascular Consultants Authorization to Use and/or Disclose Protected Information form.

All completed, signed and dated Authorization forms may be returned to:

Prairie Cardiovascular
Attn: Compliance Department
619 E. Mason Street
Springfield, IL 62701
OR E-mail:
OR fax directly to the Compliance Department: 217-522-0568

Frequently Asked Questions

What are the fees associated with requesting medical records?

PCC does not bill patients, other health care facilities, providers, or the Department of Veterans Affairs Administration (VAA) for requesting copies of patient medical records.

How do I obtain copies of my medical records?
  • An Authorization to Use/Disclose Protected Health Information must be signed by the patient or patient representative.
  • To obtain an Authorization to Use/Disclose Protected Health Information form click here.
  • Please click here for instructions on how to complete the Authorization to Use/Disclose Protected Health Information.
  • If you are unable to print the form, please contact us via the contact information.
  • Once the completed, signed and dated authorization has been received by the Compliance Department, the requested information will be sent to the recipient.
When does the authorization expire?
The authorization will expire 60 days after the date it is signed.  You may enter a different date in the third paragraph on the second page if you require the authorization to be valid for more than 60 days.  The authorization will not be valid for any time period longer than one year.
Where do I mail my completed authorization?
Please mail all authorizations to:

Attention:  Compliance Department
619 E. Mason Street
Springfield, IL 62701

What is the fax number to send my completed authorization?
Please fax your authorization to 217-522-0568.
Can I e-mail my completed authorization?
Yes.  The completed authorization can be e-mailed to
What do I need to receive medical records on a deceased patient?
A deceased person’s health information may be released upon written request from the executor or administrator of the deceased person’s estate or an agent appointed by the deceased.
What if there is no agent for the deceased?
If there is no executor, administrator, or agent and the person did not specifically object to disclosure of his or her medical records in writing then a deceased person’s health information may be released upon the receipt of the following form:  Authorized Relative Certification form
How long will it take to receive my medical records?
  • For a medical record release, it can take up to 30 days to receive your records.  We process requests in the order they are received.  However, upcoming appointments, procedures, and emergencies are processed as a STAT request.
  • We may be able to process a request same-day, given staffing and information is complete and available.  You may contact the Compliance Department to check on the status of your request.
Who processes my medical record release?
The Compliance Department processes all record requests.
Can I sign an authorization form and pick up the medical records at the same time?
Please contact the Compliance Department to arrange for medical record processing, pick-up time, and to sign an authorization.  The Compliance Department will need ample time to process the request and to ensure proper release of patient information procedures are completed.
Can someone other than the patient pick up my medical records?
Yes, records can be released to anyone the patient specifies on the authorization.  A photo I.D. is required when picking up the medical records.
Can I use the same request to send records to different locations?
No.  We require a separate authorization for each location.
Do I need a separate authorization for each PCC physician?
No, PCC has one Electronic Medical Record.  All your medical records are housed in one chart.
Why must the authorization be in writing with a date of signature?
To verify the patient’s authorization to release the health information.
If I download the Prairie Heart Institute of Illinois APP on my phone or tablet or sign-up for your newsletter, how do you use my information?
We do not collect any personal information from the Prairie Heart App. Information that you enter is stored only on your phone or mobile device and is not collected or stored by the Prairie Cardiovascular or the Prairie Heart Institute of Illinois in any way. If you opt-in to our newsletter, only your email address is stored for the purpose of sending you the newsletter. Prairie Cardiovascular and the Prairie Heart Institute of Illinois will never sell your email address and you may opt out at any time.

Notice of Nondiscrimination: English