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MyChart ® Epic Systems Corporation

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MyChart Forms



Access to another patient


To gain access to another patient's record, please fill out the form above and return it to any HSHS facility or to your provider's office participating in this MyChart portal.

MyChart Forms



Access to another patient


To gain access to another patient's record, please fill out the form above and return it to your provider's office or send it to:
Prairie Cardiovascular Consultants, Ltd
Compliance Department (HIPAA)
619 E Mason St.
Springfield, IL 62701

MyPrevea Forms



Access to another adult
Access to a child under 12
Access to a child between 12 and 17

MyChart Forms


Release of Medical Records