For other uses, see Dominic (disambiguation). Dominic is a name common among Roman Catholics and other Latin-Romans as a boys name. Originally from the late Roman-Italic name Dominicus its translation means Of Our Lord, Lordly, Belonging to God or of the Master.
ï· Call us at 1-888-693-3211. ï· Fax an eviCore healthcare request form (available online) to 1-888-693-3210. Also, to ease the administrative burden of requiring prior authorization of OB Ultrasound studies, providers may batch service requests for up to 12 weeks and cases may be reviewed retrospectively for.
We can also forward your medical record directly to another health care provider without charge. Elmhurst Hospital & Elmhurst Affiliated Practices To request a copy of your medical record, please complete the Authorization to Use or Disclose Protected Health Information and deliver in person, mail or fax to: Attn: Medical Records Department Elmhurst Memorial Hospital 155 E. Brush Hill Road Elmhurst, IL 60126 331-221-6755 Fax: 331-221-3726