Medical Record Request

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

  1. Click on the following link and print the Authorization for Use and Disclosure of Patient Health Information Form.
  1. Complete, Sign, and Date Form. Include a picture ID of patient requesting medical records.
  1. 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 53rd Ave.
    Bettendorf, IA 52722


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.