Request for Release of Information
Here is a Release of Information Form that you can use to obtain
records from Ellsworth Municipal Hospital.
Request for Release of Health
Information
Please
note that if you are obtaining your medical records for personal use,
there will be an associated fee.
Return or mail completed Release of Information form to:
Ellsworth Municipal Hospital
ATTN: Health Records
110 Rocksylvania Avenue
Iowa Falls, IA 50126-2400
Call Health Records at EMH, 641-648-7057, if you have any questions
regarding the Release of Information Form for your EMH Medical
Records.
For questions on releasing your clinic records to another provider,
please contact the Health Records staff at your clinic. |