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 firstname.lastname@example.org or mail to: Health Information Management ROI Keokuk County Health Center 23019 Hwy 149 Sigourney, IA 52591
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 email@example.com
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
Fax: (641) 224-4214