Forms and Policies

Forms and Policies

Medical Forms and Policies

Your Personal Information

The Outpatient Care Center values your privacy. We follow all HIPAA guidelines and regulations.

Privacy Act


Patient Registration

Patients are required to provide certain information during registration in order for our office to provide treatment and bill insurance for our services. Upon arrival at our office, please have insurance cards and copayments available.


New patients may print and complete registration forms prior to scheduled appointments by clicking on the forms below.

Patient Registration Form


Financial Policy

Please bring your insurance card to every visit.


For your convenience, we have answered a variety of commonly-asked financial policy questions below. If you need further information about any of these policies, please ask to speak with the Office Manager.


How May I Pay?

We accept payment by cash, check, VISA, Mastercard.


Which Insurance Plans Do You Contract With?


Plus many more insurance plans


What Is My Financial Responsibility for Services?

Your financial responsibility depends on a variety of factors, explained below.

Financial Policy


Access your Medical Record

To access your medical record, please download the Medical Records Request form. Please fill it in completely and you either may bring it with you, mail or fax back to our office at 708-229-5193. Federal law requires you complete the authorization form before we can fulfill your request. A $25 payment will be due to begin processing the medical records request and may take one to two weeks to complete. 

Access Your Medical Record Form



Family Birth Center Classes

Birthing Basics

7:00PM - 9:30 PM




Bariatric Support Group




Support Groups

Breast Feeding Support Group

11:30AM - 12:30 PM

Sep 14, 2015

Little Company of Mary Seeks Hospice Volunteers

Aug 7, 2015

Little Company of Mary Hospital Receives American College of Cardiology Award for Cardiac Care

Jul 30, 2015

LCMH Bariatric Surgery Center Earns Comprehensive Center of Excellence Re-Accreditation


My name is Charlene Heery. Dr. Richard Farrell referred me to see Debbie Murray R.N., B.S.N., C.D.E. at the D...

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