Where does the patient receive care?
Lurie Children's
Submit patient ages 12-17 Authorization Forms
Submit patient ages 18+ Authorization Forms
Pediatrust
Download patient ages 12-17 Authorization Forms
Download patient ages 18+ Authorization Forms
Other Community Pediatrics or Pediatrician Practice
Download patient ages 12-17 Authorization Forms
Download patient ages 18+ Authorization Forms
Per Illinois state law, patient consent required for full access for patients ages 12+
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