Request Medical Records Or Obtain Records From Another Provider

At DMOS, we know we’re just one part of your health and overall wellness. With our commitment to care for you from neck to toe, we make it easy to request medical records from DMOS to share with outside providers. Likewise, we simplify transfers of external medical records to our office to inform treatment and help you heal as quickly as possible.

Request Records From DMOS |  Obtain Records From Another Provider

Request Medical Records From DMOS

Records from DMOS are available to request online through the secure HealthMark portal. Patients and/or legal guardians may request medical records for personal use or to send copies to another healthcare provider for continuity of care. Using our secure online portal allows you to avoid mail delays, submit your request in a matter of minutes and get updates along the way.

  1. Follow the prompts to enter and verify your personal information.
  2. Have a copy of your government-issued photo ID or Healthcare Authority Paperwork ready to upload.
  3. Indicate if you prefer to receive updates about your request via text or email. Submit your request and receive a unique tracking number for status updates as your request is processed and completed.
Request DMOS Records For Myself Send DMOS Records To Another Provider Request Completion Of FMLA/STD Forms

Obtain Medical Records From An Outside Provider

If you need DMOS to obtain your medical records from another provider, please scroll down and complete the Medical Records Release Form below. Please note that information entered or self-disclosed on this authorization web page requesting records will be sent over the internet to DMOS. DMOS cannot guarantee the security of self-disclosed information through the internet. Once submitted, processing takes 5-7 business days.

Alternatively, patients may request secure processing via mail by printing and completing the Medical Records Release Form. Once completed, mail the form to:

DMOS Orthopaedic Centers
c/o Medical Records
6001 Westown Parkway
West Des Moines, Iowa, 50266

Patients may also fax the completed request to 515.224.5337. Mailed/faxed requests take 5-7 business days from the receipt date to be processed.

For urgent requests, please call 515.224.1414, option #6 for Medical Records.

Medical Records Release Form

Step 1: Patient Information

Step 2: Provider Information

Step 3: Types of Records to Obtain

Step 4: Medical Imaging Records Request

Step 5: Purpose of Release

Step 6: Provider Delivery Method Options

*Radiologic (X-ray, MRI, CT) images will be sent electronically as per your request on Step 4.

Step 7: Sign and Submit

Please read the following disclosure:

This authorization is effective for months but no longer than 1 year from the date on which it was signed. (If left blank this document is good for 1 year from the signature date. I understand that I may revoke this authorization at any time, except to the extent that action has already been taken in reliance upon it, by giving written notice to the Medical Records Department of the source facility. I understand that I have the right to inspect the information to be disclosed upon the proper notification to and under conditions established by the source facility. I understand that my health care and payment for my health care will not be affected if I do not sign this form. I understand this authorization is voluntary. I understand that if the recipient of this information is not a health plan or provider, the released information may no longer be protected by federal privacy regulations and may be subject to re-disclosure. I understand that I am entitled to receive a copy of this completed authorization form.

 

Prohibition of re-disclosure:

This form does not authorize re-disclosure of medical information beyond the limits of this consent. Where information has been disclosed from records protected by federal law for alcohol/drug abuse records or by state law for mental health records, and HIV/AIDS tests results, federal requirements (42 CFR Part2) and state requirements (IA Code ch.228&ch.141) (740 Ill. Comp. Stat. § 110/5) (Wis. Code §§252.15(6), 50.30) prohibit further disclosure without the specific written consent of the patient, or as otherwise permitted by such law and/or regulations. A general authorization for release of medical or other information is not sufficient for these purposes. Civil and/or criminal penalties may result from unauthorized disclosure of alcohol/drug abuse, mental health or HIV/AIDS related testing and or treatment.

 

Privacy Notice

I understand that I have the right to revoke this authorization, in writing, at any time by sending such written notification to DMOS’s Privacy Officer. Please refer to DMOS’s Notice of Privacy Practices. I understand that a revocation is not effective to the extent that DMOS has relied on the use or disclosure of the protected health information or if my authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim. I understand that information used or disclosed pursuant to this authorization may be subject to redisclosure by the recipient and may no longer be protected by federal or state law. DMOS will not condition my treatment, payment, enrollment, or eligibility for benefits on whether I provide authorization for the requested use or disclosure.

 

Signature of Patient or Personal Representative
By typing my name, I am authorizing my signature.