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Request for Release of Information

Here is a Release of Information Form that you can use to obtain records from or transfer to Mercy Medical Center - New Hampton and/or Mercy Family Clinic - New Hampton.

AUTHORIZATION TO RELEASE/OBTAIN CONFIDENTIAL INFORMATION

Please note that if you are obtaining your medical records for personal use, there will be an associated fee.
Return, fax or mail completed Release of Information form to:

Mercy Medical Center - New Hampton  
ATTN:  Medical Records
308 N. Maple Ave.
New Hampton, IA 50659
Fax: 641-394-1670

OR 

Mercy Family Clinic - New Hampton
ATTN: Medical Records
308 N. Maple Ave.
New Hampton, IA 50659
Fax: 641-394-1999

Call Medical Records at, 641-394-4121 or email nhhim@mercyhealth.com, if you have any questions about obtaining records from or transferring to Mercy Medical Center - New Hampton and/or Mercy Family Clinic - New Hampton.

©  2014 

Mercy Medical Center - New Hampton | 308 North Maple Avenue New Hampton, IA 50659 | 641-394-4121 | Clinic 641-394-2151

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