Patients and Visitors

Clinical Information Services

Instructions for Medical Records Requests/Release of Information

Release of Information Form for Hospital

Release of Information Form for Mercy Clinics

For continuity of care, please have your provider's office contact us or fax over a coversheet requesting the medical records. 
All other requests for copies of medical records must be received in writing. Print a copy of the form. If the patient is a minor (less than 18 years of age), a parent or legal guardian must sign the authorization. This form must be completed, signed, dated, then mailed, emailed, or faxed to Health Information Management at:

Mercy Hospital
Attn: Release of Information Coordinator
500 E. Market St.
Iowa City, IA 52245
Phone: 319-339-3609
Phone: 319-339-3682
Fax: 319-339-3785
Clinic email address:
Hospital email address: