Medical Records

Medical records are maintained by Health Information Management (HIM). The HIM department is available from 7:30 am to 4 pm Monday – Thursday, 7:30 am to 3 pm Friday, excluding holidays. The HIM Department is located on the lower level of the hospital near the Visiting Specialty Clinic.

To obtain a copy of your medical records:

  • Download and complete the Authorization for Release of Health Information, clearly stating the dates of service, the specific type of record(s) desired and all other information indicated on the form.
  • This form may also be obtained in HIM or you may request the form to be mailed or faxed to you.
  • Mail, fax or drop off your completed form to HIM (address/fax number below).
  • Because forms must contain original signature, e-mailed forms will not be accepted.
  • Please allow up to 30 days for requests to be processed. The average processing time is 14 business days.
  • Incomplete requests cannot be processed and will be returned for completion.
  • If you wish to have your records mailed to your physician prior to an appointment date, please indicate the appointment date on the request.
  • If you are picking up a copy of your record, a photo ID will be required. Please note that only the patient/requestor may pick up a copy of the record unless stated in the authorization.
  • The authorization must be signed by the patient or the patient’s legal representative. Legal guardian or person with durable power of attorney documentation required.
  • HIM reserves the right to contact the patient/requestor to validate the authorization prior to releasing the records.

Fees:

  • There is no cost to send copies directly to another health care provider.
  • If copies are for a patient’s personal use, the photocopying fee is $0.15 per page.

Radiology Images:

  • Radiology Images must be obtained directly through the Medical Imaging Department by calling 641-628-6759.

Contact Information:

Mail forms to:
Pella Regional Health Center
HIM-ROI
404 Jefferson St.
Pella, Iowa 50219

Fax forms to: (641) 621-2220

If you need additional information please contact Health Information Management at 641-628-6662.
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