Medical Records Request

Click here to download Authorization for Release of Information. Please print the form and fill it out and sign.

You can sign for your minor children that are under 18 years old. If you have guardianship of a minor, please send appropriate guardianship papers with release.

If you are a POA or executor for an estate, we will need appropriate papers sent with release of information.

You can mail, email or fax your completed release.

Mailing address:

Madison County Health Care System
Health Information Management
300 W. Hutchings St.
Winterset, Iowa  50273

Email addresses:

Fax number:


Cost for patients medical records for personal use:

CD:  $6.50 flat fee
Emailed:  $6.50 flat fee
Paper copy:
0-19 pages:  free
20+ pages:  $1.00 plus $.05 per page

Payment is expected at time of pickup or before emailing or mailing.

Payment can be made with cash, credit or debit card.  These payments can be made in person in Health Information Management Department or by phone, with credit or debit card.

*There is no charge for records you request to be sent directly to another clinic or hospital.
**Per hospital policy we have a 10 day turnaround.

We do have a patient portal available for you to access medical records for yourself, minor children or if you are a guardian for someone.   Please contact Cassey or Shelley for information on how to set up your patient portal.

Cassey  515-462-2373  Ext. 296
Shelley  515-462-2373 Ext. 298

Please feel free to call us with any questions.

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