How to Fill Out the Walgreens Custodian of Records Request Form

To request your records from Walgreens, download the appropriate authorization form from Walgreens.com, fill it out completely, sign it by hand, and send it to the Walgreens Custodian of Records at 1901 East Voorhees Street, MS 735, Danville, IL 61834. The request form is processed in Danville, not at the corporate headquarters in Deerfield, and Walgreens has 30 calendar days from receipt to respond.

Pick the Right Form First

Walgreens uses two different forms, and choosing the wrong one delays your request.

If you are the patient asking for your own records, use the Access Form, titled “Request to Access, Inspect, or Obtain Protected Health Information.”¹ It has an optional section for sending your records to a third party such as a new doctor or an insurance company, so you do not need a separate form just because the records are going somewhere other than your own mailbox.

If someone else — an attorney, an insurer, or a family member — is the one requesting your health information, use the Third-Party Authorization Form, titled “Authorization – For Release of Information to Third Party.”² The patient still has to sign it.

Your right to obtain your own records comes from the HIPAA Privacy Rule, which lets you inspect and copy protected health information held about you in a covered entity’s designated record set.³ Standard pharmacy records fall squarely within that right.

Decide What Records You Need

The Access Form gives you several checkboxes for the type of record:¹

Entire Prescription History — every prescription filled at Walgreens during the dates you specify.
Immunization Record — vaccines administered at a Walgreens pharmacy or clinic.
COVID-19 Test Results — results from tests done at Walgreens locations.
Buyout Records — prescriptions transferred to Walgreens when your original pharmacy was acquired; you need to provide the original pharmacy’s name.
Records Other — a free-text field for anything that does not fit the categories above.

Walgreens Healthcare Clinic records — the in-store clinics staffed by nurse practitioners — are handled as a separate category. If you need visit notes, lab results, or treatment summaries from a clinic visit, list the specific dates of service on the form.⁴

Narrow your date range as much as you can. A request for “all records ever” takes longer to fulfill than one aimed at a specific window.

Complete Each Section Carefully

Patient Information

Enter the patient’s full legal name, date of birth, and mailing address. The name must match what was on file at the pharmacy when the prescriptions were filled, because that is how the Custodian of Records finds your file. If you have changed your name since then, note the previous name in the additional information section.¹

Date Range and Record Type

Fill in the start and end dates for the period you want covered, and check the box for the record type. For buyout records, write in the name of the original pharmacy. Use the Records Other field to describe anything that does not have its own checkbox.

Third-Party Recipient

Complete this section only if you want the records sent to someone other than yourself. You will need the recipient’s name, address, and relationship to you. Leave it blank to have the records mailed to your own address. On the separate Third-Party Authorization Form, the instructions in Section 3 need enough detail for Walgreens to see the scope of what you are authorizing.²

Signature

Sign and date the form by hand. Walgreens does not accept typed signatures.¹ This is the most common reason requests get bounced back. If you fill in the PDF on your computer, print it, sign in ink, and then scan the signed page for electronic submission.

For Healthcare Clinic records, Walgreens also asks that you send a copy of a photo ID along with the authorization form.⁴

Send the Form to Danville

All completed forms go to the same office. You have three ways to submit:¹

Mail: Walgreens Custodian of Records, 1901 East Voorhees Street, MS 735, Danville, IL 61834. Certified mail with return receipt gives you proof of when Walgreens received the request, which matters because the 30-day response clock starts on receipt.
Fax: (217) 554-8955.
Email: myrecords@walgreens.com. Attach the signed, scanned form as a PDF.

The department’s phone number is (217) 554-8949 if you need to ask a procedural question or check on a pending request.²

Do not send records requests to the Walgreens corporate address in Deerfield, Illinois. That office handles general customer service and will not process your form.⁵

What It Costs

Walgreens can charge a reasonable, cost-based fee for copies. Under HIPAA that fee is limited to labor for copying, supplies for paper or electronic media, and postage when you ask for mailed copies.³

When your records are kept electronically and you request an electronic copy, Walgreens has the option of charging a flat fee of no more than $6.50 per request instead of itemizing costs. That ceiling covers labor, supplies, and postage combined.⁶ The $6.50 cap applies only when the patient is requesting their own records. Attorneys, insurance adjusters, and record retrieval companies do not qualify for it and may be billed under state-regulated per-page rates that vary widely by jurisdiction.

How Long It Takes

Walgreens has 30 calendar days from receiving your completed form to act on the request. If it cannot finish inside that window, it can take one additional 30-day extension, but only if it sends you a written explanation of the delay and the expected completion date before the first 30 days run out.⁷ The Access Form itself notes this timeline.¹

Healthcare Clinic records often come back faster. Walgreens states a minimum of four business days for clinic-specific requests received during normal business hours, Monday through Friday, 8 a.m. to 4 p.m. CST.⁴

Records are delivered as digital files or hard-copy mail depending on what you asked for. If you listed a third-party recipient, the records go directly to that person or organization.

If Walgreens Denies Your Request

Denials are allowed in limited situations, and the Access Form itself flags that possibility. A written denial has to explain why and tell you how to request a review. You can ask that a licensed healthcare professional who was not involved in the original decision review it, and that reviewer must reach a determination within a reasonable period.³

If the internal review does not resolve the problem, you can file a complaint through Walgreens’ privacy complaint process or with the U.S. Department of Health and Human Services Office for Civil Rights, which enforces HIPAA. Contact information for both has to appear in the denial letter.

Records for a Lawsuit Need a Subpoena Instead

If you need Walgreens records for litigation — incident reports, surveillance footage, or store-level documentation of an accident — a HIPAA authorization form is generally not the right tool. Those materials require a subpoena duces tecum. Walgreens’ privacy notice confirms it may disclose health information in response to a court order or subpoena when the requesting party or Walgreens has made efforts to notify the patient or obtain a protective order.⁸ An attorney handles the subpoena mechanics, and subpoenaed records typically take longer than a standard HIPAA request because of the added notice requirements.

Confirm the Records Still Exist Before You Wait

Retention periods depend on the record type. Walgreens Healthcare Clinic electronic medical records are kept for ten years after your last date of service at the clinic.⁴ Pharmacy prescription records are governed by state pharmacy board rules, and most state minimums fall between two and ten years. Controlled substance dispensing records have a federal floor of two years under DEA rules, and state law is often longer.⁹

If you are asking for prescription history from a decade or more back, call the Custodian of Records office at (217) 554-8949 before you complete the form to confirm the records still exist. Once you know they do, submit the request as soon as you can.

1
Walgreens. Request to Access, Inspect, or Obtain Protected Health Information
2
Walgreens. Authorization – For Release of Information to Third Party
3
eCFR. 45 CFR 164.524 – Access of Individuals to Protected Health Information
4
Walgreens. Health Records and Billing
5
Walgreens. Customer Service
6
U.S. Department of Health and Human Services. Is $6.50 the Maximum Amount That Can Be Charged
7
U.S. Department of Health and Human Services. How Timely Must a Covered Entity Be
8
Walgreens. Notice of Privacy Practices
9
U.S. Department of Justice Drug Enforcement Administration. Pharmacist’s Manual