Contact Us

We are located at:                                                                                                                                   23019 Hwy 149,                                                                                                                                 Sigourney, IA, 52591                                                                                                                             Phone: 641-622-2720  Answered 24 hours                                                                                             Fax: 641-622-1187

Our Business Office is open Monday-Friday 7 AM-5 PM.

Release of Information

For Medical Record Requests – Complete AND SAVE form.  If you do not save it, it will be blank when we receive it.  You may email the completed form to kchcroi@kchc.net or mail to:                                                                  Health Information Management ROI                                                                                                            Keokuk County Health Center                                                                                                                        23019 Hwy 149                                                                                                                                              Sigourney, IA 52591

Iowa-HIPAA-Medical-Release-Form

If you would like access to your medical record, please talk to your health care team. You have a right to review, on request, a copy of your medical record and/or receive a copy of your medical record for reasonable copying charges.  You may also access your medical record information quickly and electronically through patient portal. If you do not yet have a patient portal account you can stop by the nurses station and request one.

Use our HIPAA-compliant form to authorize the release of medical information – Consent to Release Form

To request a printed form be sent to you via e-mail or by mail, please e-mail roikchc@kchc.net

To avoid delays in processing, please review the form carefully and complete all sections. The form must be signed and dated.  If the patient is a minor (less than 18 years of age), a parent or legal guardian must sign.

The preferred method to receive medical record requests is in writing. However, in emergencies, requests may be sent via e-mail or fax.

Questions regarding release of information or the form, may be directed to the Release of Information Office at (641) 622-1149, Monday through Friday between 8 a.m. to 5 p.m.

Send medical record requests to:

Health Information Management (Medical Records)
Keokuk County Health Center

23019 Hwy 149

Sigourney, IA  52591

Email: roikchc@kchc.net
Fax:    (641) 224-4214