Patients and Visitors

Clinical Information Services

Instructions for Medical Records Requests/Release of Information

Release of Information Form for Hospital

All 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 and mailed or faxed to Clinical Information Services Department at:

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

Release of Information Form for Mercy Clinics

All 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 and mailed or faxed to Clinical Information Services Department at:

Mercy Clinics
Attn: Release of Information Coordinator
500 E. Market St.
Iowa City, IA 52245
Phone: 319-688-7660
Fax: 319-358-2641