Other Requests Related to Your Health Records

Other Requests Related to Your Health Records

To request an amendment or restriction of your health information, or to obtain an accounting of disclosures:

Download and complete all fields on the appropriate form

Submit the form by:

  • Fax: 312.926.7686
  • Email: nmhprivacy@nm.org
  • Mail: ATTN: Data Integrity Patient Privacy 676 N St Clair Street Suite 1840 Chicago, IL 60611