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Medical Records Request

Medical Records Request

To request medical records, please submit a signed record request to our Medical Records department.

Where to find our form:

  1. Online via printing the form at this link
  2. In person at the facility
  3. Contact our records department at 217-373-1740 to have the form faxed or mailed to you.

Where to return the form:

  1. Mailing address:
    The Pavilion Behavioral Health System
    Attn: Medical Records
    809 W Church St. Champaign Il, 61820
  2. Via fax: 217-373-1767

Special Notes:

Authorizations expire one year from the signature date unless otherwise specified. Authorizations for the records the facility maintains must all include a witness signature. Please call the Medical Records department with any questions at 217-373-1766.