You have a right to review, on request, a copy of your medical record and/or receive a copy of your medical record for reasonable copying charges. You may also access your medical record information (test results) quickly and electronically with a myHealth account.
All requests and copies for medical record information must be received in writing by using our HIPAA-compliant Authorization to Disclose Protected Health Information form to authorize release of medical information. This form is used for releasing records out and obtaining records from.
Medical record requests will be processed within 30-days. To avoid delays in processing, please review the form carefully and complete all sections. If the patient is a minor (less than 18 years of age) a parent or legal guardian must sign. Please note, you must have a signature of a witness on each form you submit.
Send the completed signed form with verification of legally qualified* status to:
Regional Medical Center/Regional Family Health
P.O. Box 359
Manchester, IA 52057
RMC – Fax 563-927-7927
Regional Medical Home Care and Hospice of Comfort – Fax 563-927-7444
Regional Family Health Fax – 563-927-7660
*What it means to be legally qualified:
Written consent of the patient or his/her legally qualified representative is required for release of information from the medical record. Legally qualified representative is defined as guardian of a minor child or a person possessing Power of Attorney status or Executor of Estate status, with verification of such status.
Medical records will be sent within 30 business days to address provided if form is completed in its entirety. There may be a minimal fee for a request for records in order to cover copying costs.
Consider Using myHealth
Patients of Regional Medical Center/Regional Family Health may also access medical record information (test results) quickly and electronically with a myHealth account. If you do not yet have a myHealth account you may request an invitation at your next visit or by calling the Health Information Services Department at 563-927-7433.
Adults may authorize another adult to view their health records by completing an authorization form allowing access to their protected health information; however, it is strongly encouraged to create separate accounts. If felt necessary, this form must be completed by visiting the Health Information Services Department Monday-Friday between the hours of 8:00 am - 4:30 pm or by completing the appropriate myHealth Adult/Adult Portal Access Authorization form.
Medical Treatment Authorization for Minor form:
Medical Treatment Authorization for Minor form
If you plan to have someone else bring your child in for their appointment complete the Medical Treatment Authorization for Minor form
Send completed signed form(s) to:
PO Box 359
Manchester, IA 52057
RFH Fax: 563-927-7660
RMC Fax: 563-927-7927
If you have any questions please call 563-927-7433 or email email@example.com.
Park in Lot "4" and use Entrance "G" (Regional Family Health Main Entrance). At the Regional Family Health Reception desk, ask to speak with Medical Records.