Ellsworth Municipal Hospital

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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.

©  2014 

Hansen Family Hospital | 920 South Oak Street | Iowa Falls, Iowa 50126 | 641-648-4631

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