We share our suggestions for ordering neurological records from Rush University (University Medical Center, Copley Medical Center, and Oak Park Hospital)
GENERAL GUIDELINES
As noted in our generic instructions for ordering neurological records from any institution, the brain bank:
- now requires that records be at the brain bank prior to the passing of the intended brain donor
- neurological records ONLY are needed. No primary care physician records or hospice records. In the cases of Parkinson’s Disease, only the most recent 6-8 years of records are needed.
- it is always easiest to download neurological records via the online patient portal. If you don’t have access to the online patient portal, records must be ordered from the medical records office or clinic. Records can be sent from medical records offices or clinics directly to the brain bank. One advantage of this approach is that there may be no fee to the family. One disadvantage of this approach is that the family has no real way to confirm that records have been sent.
- ideally, records should be sent to the brain bank by email or posted to the cloud for download by the brain bank. Second choice is by fax. Third choice is by mail with tracking. Last choice is by mail with no tracking.
- ordering records and following up with the medical records offices or clinics is the family’s responsibility
Source: JDG/Pixabay
RUSH INFORMATION
These suggestions are derived from speaking with staff from the medical records office and viewing helpful webpages, including:
There are two main ways to request medical records from Rush.
1. Download records through MyChart online patient portal.
Downloaded records may be submitted to Mayo Clinic by:
- Secure email to Dennis Dickson, MD, ℅ the Brain Bank Coordinator, Rachel LaPaille-Harwood, at [email protected]
- Post to the cloud (Google Drive, Dropbox, Box, or other online file sharing service). Then email link to file(s) to the Brain Bank Coordinator, Rachel LaPaille-Harwood, at [email protected]
- Fax to 904-953-7117 (Attn: Dennis Dickson, MD)
- US Mail to Dennis Dickson, MD, Mayo Clinic Jacksonville, Birdsall 310, 4500 San Pablo Road, Jacksonville, FL 32224-1865 (phone 904-953-2439)
2. Request medical records directly from Rush hospitals. The exact process varies depending on the specific hospital where the donor received care. Please see the instructions below for each location.
Rush University Medical Center
Download the Authorization Form to authorize the release of health information. The form is available in English, Spanish, or Mandarin. (A list of fees can be viewed here.)
-> Provide Details: Be sure to provide as much detail as possible when completing the form, including specific dates of service and the names of providers. This will help expedite your request.
-> Release Requested Medical Information to: Dennis Dickson, MD, Mayo Clinic Jacksonville, Birdsall 310, 4500 San Pablo Road, Jacksonville, FL 32224-1865 (phone 904-953-2439, fax 904-953-7117)
-> Purpose: The form asks for a reason for the release of information. Please check the box next to “Other (specify)” and write in or type either “medical research,” “clinical-pathological correlation,” or “brain bank research.”
-> Preferred Format: Check the box for “Secure email address” and provide email address – [email protected]
-> Dates of Service to Release (FROM/TO): If you do not recall specific dates, use a broad date range to capture all the visits/appointments. Be sure to include an actual ending date. Be careful when completing the authorization form if completing in advance. The authorization request does not apply to dates beyond the date of signature.
-> Requested Medical Information: Beneath the date range, check any/all boxes for the type of records that may apply. (Note: Mayo will want any reports from scans, images, or testing but does not need the actual images themselves.) You may check the box for “Other” in Step 1 and add “All neurologically-related reports” in the appropriate field in Step 2.
-> Signatures: The authorization form must be completed thoroughly, dated, and signed. It is best if the intended donor signs the form. If the intended donor is signing the form, return it via fax or US mail along with a legible copy of a driver’s license or state ID card.
If the intended donor is not able to sign, the medical power-of-attorney should sign his/her name. When you fax or mail the completed authorization form, include the medical power-of-attorney document and a photograph of the medical power-of-attorney’s government-issued ID.
Submit the completed form to Rush University Medical Center via mail to:
- Fax 312-942-2264
- Rush University Medical Center, ATTN: Health Information Management Office, 1611 W. Harrison St., L1, Suite 001, Chicago, IL 60612
Your request will be processed within seven to fourteen days. We suggest a follow-up call to the Rush University Medical Center Health Information Management Office a week after submitting the authorization form. Inquire when the records were sent (or will be sent) and confirm the delivery method. Make a note of the date and method of delivery. The Health Information Management Office can be reached at 312-942-7262, Monday through Friday, from 8:00 am to 4:30 pm.
Rush Copley Medical Center
Download the Authorization Form to authorize the release of health information. The form is available in English or Spanish. A list of fees can be viewed here.
-> Provide Details: Be sure to provide as much detail as possible when completing the form, including specific dates of service and the names of providers. This will help expedite your request.
-> Release Requested Medical Information to: Dennis Dickson, MD, Mayo Clinic Jacksonville, Birdsall 310, 4500 San Pablo Road, Jacksonville, FL 32224-1865 (phone 904-953-2439, fax 904-953-7117)
-> Purpose: The form asks for a reason for the release of information. Please check the box next to “Other (specify)” and write in or type either “medical research,” “clinical-pathological correlation,” or “brain bank research.”
-> Preferred Format: Check the box for “Secure email address” and provide email address – [email protected]
-> Dates of Service to Release (FROM/TO): If you do not recall specific dates, use a broad date range to capture all the visits/appointments. Be sure to include an actual ending date. Be careful when completing the authorization form if completing in advance. The authorization request does not apply to dates beyond the date of signature.
-> Requested Medical Information: Beneath the date range, check any/all boxes for the type of records that may apply. (Note: Mayo will want any reports from scans, images, or testing but does not need the actual images themselves.) You may check the box for “Other” in Step 1 and add “All neurologically-related reports” in the appropriate field in Step 2.
-> Signatures: The authorization form must be completed thoroughly, dated, and signed. It is best if the intended donor signs the form. If the intended donor is signing the form, return it via fax or US mail along with a legible copy of a driver’s license or state ID card.
If the intended donor is not able to sign, the medical power-of-attorney should sign his/her name. When you fax or mail the completed authorization form, include the medical power-of-attorney document and a photograph of the medical power-of-attorney’s government-issued ID.
Submit the completed form to Rush Oak Park Hospital via:
- Fax 630-978-6858
- Mail or Hand-Deliver (Rush Copley Medical Center Medical Records Department (lower level of hospital), ATTN: Medical Records Department, 2000 Ogden Ave., Aurora, IL 60504)
Your request will be processed within five days. We suggest a follow-up call to the Rush Copley Medical Center Health Information Management Office 5 days after submitting the authorization form. Inquire when the records were sent (or will be sent) and confirm the delivery method. Make a note of the date and method of delivery. The Medical Records Department can be reached at 630-978-6786, Monday through Friday, from 8:00 am to 4:30 pm.
Rush Oak Park Hospital
Download the Authorization Form to authorize the release of health information. The form is available in English, Spanish, or Mandarin. (A list of fees can be viewed here.)
-> Provide Details: Be sure to provide as much detail as possible when completing the form, including specific dates of service and the names of providers. This will help expedite your request.
-> Release Requested Medical Information to: Dennis Dickson, MD, Mayo Clinic Jacksonville, Birdsall 310, 4500 San Pablo Road, Jacksonville, FL 32224-1865 (phone 904-953-2439, fax 904-953-7117)
-> Purpose: The form asks for a reason for the release of information. Please check the box next to “Other (specify)” and write in or type either “medical research,” “clinical-pathological correlation,” or “brain bank research.”
-> Preferred Format: Check the box for “Secure email address” and provide email address – [email protected]
-> Dates of Service to Release (FROM/TO): If you do not recall specific dates, use a broad date range to capture all the visits/appointments. Be sure to include an actual ending date. Be careful when completing the authorization form if completing in advance. The authorization request does not apply to dates beyond the date of signature.
-> Requested Medical Information: Beneath the date range, check any/all boxes for the type of records that may apply. (Note: Mayo will want any reports from scans, images, or testing but does not need the actual images themselves.) You may check the box for “Other” in Step 1 and add “All neurologically-related reports” in the appropriate field in Step 2.
-> Signatures: The authorization form must be completed thoroughly, dated, and signed. It is best if the intended donor signs the form. If the intended donor is signing the form, return it via fax or US mail along with a legible copy of a driver’s license or state ID card.
If the intended donor is not able to sign, the medical power-of-attorney should sign his/her name. When you fax or mail the completed authorization form, include the medical power-of-attorney document and a photograph of the medical power-of-attorney’s government-issued ID.
Submit the completed form to Rush Oak Park Hospital via:
- Fax 708-660-4026
- Mail (Rush Oak Park Hospital, ATTN: Medical Records Department, 520 S. Maple Ave., Oak Park, IL 60304)
Your request will be processed within seven to fourteen days. We suggest a follow-up call to Rush Oak Park Hospital Health Information Management Office a week after submitting the authorization form. Inquire when the records were sent (or will be sent) and confirm the delivery method. Make a note of the date and method of delivery. The Medical Records Department can be reached at 312-942-7262, Monday through Friday, from 7:30 am to 4:00 pm.