Medical Records | Humboldt County Memorial Hospital

Authorization Form

Download the Authorization Form, complete and return to Humboldt County Memorial Hospital Health Information Management.

For the Spanish version please complete the following form.

Para la versión en español por favor complete el siguiente formulario.

An authorization must be completed in its entirety to receive a copy of your medical records. Please mail the authorization back to Humboldt County Memorial Hospital’s Health Information Management at the address listed below or bring in the request during the Release of Information hours listed below. Please note: There could be a fee based on the type of requests.

To transfer medical records to another provider, please have your new provider contact Humboldt’s Health Information Management (HIM) Department.

Medical Records (HIM) Department Address:
Humboldt County Memorial Hospital
Attn: HIM Department
1000 North 15th Street
Humboldt, IA 50548

Lab, X-ray, ER and clinical visit notes are now available through MyUnityPoint’s online patient portal. You may register by visiting https://chart.myunitypoint.org/mychart/

Release of Information Hours:
Monday - Friday
8:00 a.m. - 4:00 p.m.

Luann Christopher, Health Information Management (Medical Records)
1000 15th Street North, Humboldt, IA 50548
Phone: (515) 332–7686 | Fax: (515) 332-7676