PATIENT CENTER

Medical Record Request

To manually request your medical records, please complete the following:

Click on the following link and print the Authorization for Use and Disclosure of Patient Health Information Form.

Complete, Sign, and Date Form. Include a picture ID of patient requesting medical records.

Return Form to ORA Orthopedics by:

Fax to ORA Medical Records: (563) 324-0615 or (309) 762-3690

or –

Hand Deliver to any Clinic Location

or –

Mail to ORA Orthopedics
Medical Records Department
2300 53^rd Ave.
Bettendorf, IA 52722

IMPORTANT

A picture ID of patient requesting medical records must be included when faxing or mailing the medical release form. If the medical release form is hand delivered to a clinic location the patient must present a picture ID.

Please allow 7 to 10 business days to complete your request. Once the completed release form with patient picture ID is received in the Medical Records Department, your request will be processed.

Quick Links

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