Requests for Medical Records

MercyOne Genesis protects the confidentiality of your medical records, while providing you or your authorized representative access when you need them. Also known as Protected Health Information (PHI), your medical records are available to you on paper or CD. There is no charge for a copy of medical records.

Below is information on how you can request copies of your medical records, depending on the type of information you need. If you still have questions, contact the MercyOne Genesis Health Information Management (HIM) office at (563) 421-7260.

Hospital | Radiology

Hospital & Physician Office Medical Records

To request a copy of your hospital medical records for yourself, print and complete the Authorization for Use and Disclosure of Protected Health Information form, then:

• Bring the completed form to the MercyOne Genesis HIM office, located at 1401 West Central Park Avenue, Suite 3200, Davenport. A short wait will be required while we process your request.
• OR fax the completed form to the HIM office:
  (563) 421-7289
• OR mail the completed form to the HIM office:
  MercyOne Genesis Health Information Management
  1401 West Central Park Avenue
  Suite 3200
  Davenport, IA  52804
• The HIM office is open Monday through Friday, from 8 a.m. to 4:30 p.m.

If you need your medical records sent to another health care provider outside of MercyOne Genesis for continuity of care, completion of the authorization form is not necessary. Simply call the HIM office at (563) 421-7260 to direct where your records should be sent.

Requesting Other Types of Records

Radiology Images or Imaging Films

We can provide you with a CD that contains your imaging study (the images obtained by X-Ray, MRI, CT, etc.) and/or the report prepared by the Radiologist who has analyzed it.

• The copy of your imaging study (images) can only be picked up by coming to one of our hospital imaging departments or outpatient imaging centers listed below.
• Request your copy in person or call ahead. If you do not call ahead, a short wait will be required while we process your request.
• The imaging departments/centers can ONLY provide a copy of your images.
• The MercyOne Genesis HIM office cannot provide a copy of your images.
• The HIM office can provide a copy of the Radiologist’s report.
• You must show identification and complete and sign the Authorization for Use and Disclosure of Protected Health Information form.
• There is no cost.

GMC-East Rusholme Street Imaging – (563) 421-6160
GMC-West Central Park Imaging – (563) 421-1160
GMC-Silvis Imaging – (309) 281-4140
GMC-Aledo Imaging – (309) 582-9140
GMC-DeWitt Imaging – (563) 659-4270
53^rd Street Imaging Center, Davenport – (563) 421-9729
Bettendorf Imaging Center – (563) 421-3760
Moline Imaging Center – (309) 281-6260

Questions about all other medical information/tests/records should be directed to the HIM office at (563) 421-7260.

Other Information You May Need to Know

If you are requesting records for a patient who lacks legal capacity or is unable to sign, an authorized personal representative may sign the Authorization for Use and Disclosure of Protected Health Information form. Written proof of authority should accompany the request in order to verify appropriate health information access for the following:

• Court-appointed guardian or other legally appointed representative
• Executor/administrator/attorney in fact
• Affidavit next-of-kin
• Power of Attorney

Verification of identity is required. Fees may apply. If you have questions, call the HIM office at (563) 421-7260.