Illinois Compiled Statutes 735 ILCS 5/8-2001.5 – Authorization for release of a deceased patient’s records
(1) the deceased person’s surviving spouse; or
Attorney's Note
Under the Illinois Statutes, punishments for crimes depend on the classification. In the case of this section:Class | Prison | Fine |
---|---|---|
Class 3 felony | between 2 and 5 years | up to $25,000 |
Terms Used In Illinois Compiled Statutes 735 ILCS 5/8-2001.5
- Executor: A male person named in a will to carry out the decedent
- Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC
- Surviving spouse: means "widow" or "widower" as the case may be. See Illinois Compiled Statutes 5 ILCS 70/1.32
(2) if there is no surviving spouse, any one or more
of the following: (i) an adult son or daughter of the deceased, (ii) a parent of the deceased, or (iii) an adult brother or sister of the deceased.
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(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:
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.)