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Request medical records information

To submit a request for a Rosecrance client medical record, find the forms you need, download and fill them out, and submit them to the location associated with your treatment.

Medical record forms

Authorization to Release Information

The Authorization to Release Information disclosure allows the sharing of treatment information to coordinate care.

Request for Access to Inspect or Copy Client Record

The Request for Access to Inspect or Copy Client Record form must be filled out when client information is being requested.

Illinois Petitioner Treatment Verification

The Illinois Petitioner Treatment Verification is part of the Illinois Secretary of State’s Department of Administrative Hearings, and is filled out for providers once drivers within the state have completed treatment.

For healthcare organizations wanting to request or exchange information

CareConnect Inbox is a fully integrated, direct messaging platform within Netsmart CareRecords. It supports secure external communication with the broader healthcare community through direct messaging. This allows us to communicate with other organizations that also use direct secure messaging. CareConnect Inbox supports HIPAA-compliant communication for both internal and external delivery through direct secure messaging.

Illinois:

[email protected]

Iowa:

[email protected]

Aspen:

[email protected]

Submit your form

Each form should be submitted to the Rosecrance entity responsible for the client service. Forms may be submitted by mail, fax, or email. For questions, please call or email the correct location.

  • Mailing address

    Rosecrance Behavioral Health
    Attn: Medical Records Department
    1021 N. Mulford Road
    Rockford, IL 61107

    Call

    (815) 720-4940

    Fax

    (815) 720-5089

    Email

    [email protected]

  • Mailing address

    Rosecrance Jackson Centers
    Attn: Medical Records Department
    800 5th Street
    Sioux City, IA 51101

    Call

    (712) 234-2324

    Fax

    (712) 258-5679

    Email

    [email protected]

  • Mailing address

    Connections Counseling
    5005 University Avenue, Suite 100
    Madison, WI 53705

    Call

    (608) 233-2100 ext 0

    Fax

    (608) 233-2101

    Email

    [email protected]

  • Mailing address

    Aspen Counseling
    8616 Northern Avenue,
    Rockford, IL 61107

    Call

    (815) 399-9700

    Fax

    (815)-720-5089

    Email

    [email protected]

Speak to a Rosecrance team member

We’re here to talk; contact Rosecrance to understand your options, answer your questions, provide information, and more.

Get Help Now (866) 330-8729