Privacy and Consent Forms

PDF Notice of Privacy Practices (Requires Acrobat Reader)

• English
• Spanish

PDF Consent Forms (Requires Acrobat Reader)

• Request Restrictions and/or Request Confidential Communications Form
  
• Request for Amendment of Health Information Form
  
• Authorization to Use or Disclose Protected Health Information
  
• Law Enforcement Request for Protected Health Information
  

Elmhurst Memorial Healthcare Network

This site is part of the Elmhurst Memorial Healthcare network of Web sites, which covers a variety of topics using the same philosophy: When it comes to medical care, we know that you have a lot of options. And we want you to know that you're more than a patient to us. You're an individual. We would appreciate the opportunity to provide you with state-of-the-art medical care and down-to-earth, personalized attention.

Visit These Elmhurst Memorial Healthcare Web Sites:

• » Elmhurst Memorial Healthcare
• » EMH Foundation
• » Elmhurst Clinic

• » EMH Reference Lab
• » Elmhurst Memorial Hematology Oncology Associates
• » Elmhurst Primary Care Associates
• » Elmhurst Medical Associates