Release of The University of Chicago Medicine Materials (Slides and/or Blocks) to a Patient and/or Outside Institution per Patient's Request:
Fill out and sign UCMC Patient Authorization Form for Release of Medical Records (in Section II: INFORMATION REQUESTED” -- under "Other" -- specify Pathology Materials (can list blocks, slides, reports, if known)). A signed Acknowledgement & Indemnity Agreement – Pertaining to Release of Original Patient Material must be obtained from the patient or patient’s Power of Attorney (POA). These forms may be turned in:
- In-person; or
- Faxed (via Pathology Patient Request line: 773-926-0724); or
- Emailed (via Pathology Patient Request email address: PathologyPatientRequests@uchospitals.edu).
If the patient or designee does not send a UCMC Patient Authorization Form for Release of Medical Records along with a signed Acknowledgement & Indemnity Agreement – Pertaining to Release of Original Patient Material in advance, he/she must complete the forms when picking up the materials.
When picking up the requested materials, identification must be provided. Acceptable identification includes but is not limited to a government issued ID.