Click here to download a copy of the medical records request. 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:


If you have any questions please call or email Health Information Management department at 515-462-2373 and select option for Health Information Management or you can email at above email address(s).

It is the policy of Madison County Health Care System to have records sent out within 10 days of receiving a completed release of information.