(735 ILCS 5/8-2001.5)
Authorization for release of a deceased patient's records.
(a) In addition to disclosure allowed under Section 8-802, a deceased person's health care records must be released upon written request of the executor or administrator of the deceased person's estate or to an agent appointed by the deceased under a power of attorney for health care. When no executor, administrator, or agent exists, and the person did not specifically object to disclosure of his or her records in writing, then a deceased person's health care records must be released upon the written request of a person, who is considered to be a personal representative of the patient for the purpose of the release of a deceased patient's health care records, in one of these categories:
(1) the deceased person's surviving spouse; or
(2) if there is no surviving spouse, any one or more
(b) Health care facilities and practitioners are authorized to provide a copy of a deceased patient's records based upon a person's payment of the statutory fee and signed "Authorized Relative Certification", attesting to the fact that the person is authorized to receive such records under this Section.
(c) Any person who, in good faith, relies on a copy of an Authorized Relative Certification shall have the same immunities from criminal and civil liability as those who rely on a power of attorney for health care as provided by Illinois law.
(d) Upon request for records of a deceased patient, the named authorized relative shall provide the facility or practitioner with a certified copy of the death certificate and a certification in substantially the following form:
AUTHORIZED RELATIVE CERTIFICATION
I, (insert name of authorized relative), certify that I am an authorized relative of the deceased (insert name of deceased). (A certified copy of the death certificate must be attached.)
I certify that to the best of my knowledge and belief that no executor or administrator has been appointed for the deceased's estate, that no agent was authorized to act for the deceased under a power of attorney for health care, and the deceased has not specifically objected to disclosure in writing.
I certify that I am the surviving spouse of the deceased; or
I certify that there is no surviving spouse and my relationship to the deceased is (circle one):
(1) An adult son or daughter of the deceased.
(2) Either parent of the deceased.
(3) An adult brother or sister of the deceased.
I certify that I am seeking the records as a personal representative who is acting in a representative capacity and who is authorized to seek these records under Section 8-2001.5 of the Code of Civil Procedure.
This certification is made under penalty of perjury.*
Dated: (insert date)
(Print Authorized Relative's Name)
(Authorized Relative's Signature)
(Authorized Relative's Address)
*(Note: Perjury is defined in Section 32-2 of the Criminal Code of 2012, and is a Class 3 felony.)
(Source: P.A. 97-623, eff. 11-23-11; 97-867, eff. 7-30-12; 97-1150, eff. 1-25-13