Medical Records Release - Hospital Records Only

To receive a copy of your medical records please follow these 3 steps:

  1. Print form:  Authorization for access, use or disclosure of protected health information (pdf)
  2. Fill out form.
  3. Fax to Mercy at 515-643-8813.

Please fill out the authorization request form in complete detail along with the patients signature and date of the signature.  If the patient is unable to sign at the bottom of the request, please provide the appropriate legal documentation needed to prevent any delays in retrieving records.


*IF you are requesting clinical records please contact your clinic, we do not have access to those records. Thank you.  The Mercy HIM Department

You can also mail your request form to us at:

Attn: Medical Records
Mercy Medical Center
1111  6th Avenue
Des Moines, IA 50314

(515) 247-3121
1111 6th Avenue
Des Moines, Iowa 50314

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