Gold Coast Gynecology
If you would like to schedule an appointment or a consultation please call 312.440.1600

FORMS

As a convenience for our patients, we offer many of our forms online.

NEW PATIENT AND PATIENT UPDATE FORMS:

REQUEST FOR MEDICAL RELEASE FORM:

Per HIPAA requirements, Gold Coast Gynecology requires patients to provide a completed medical records release form for every instance that your medical records leave our offices to ensure your privacy. Because medical records contain your protected health information (PHI), the completed medical records release form must be returned to our office via fax, mail or in person. To protect your health information, Gold Coast Gynecology will not transmit your medical records via email.

According to 735 ILCS 5/8-2001 requirements related to the examination of health care records, Gold Coast Gynecology has up to 30 days to complete your medical records request, although many requests may be processed sooner.

As always, if you have any questions, please contact our office.

Gold Coast Gynecology
680 N. Lake Shore Dr., Suite 114
Chicago, Illinois 60611
Phone: 312.440.1600
Fax: 312.440.3508
www.goldcoastgyn.com

Obstetrics & Gynecology, P.C. d/b/a/ Gold Coast Gynecology