Medical Release

For a release of medical records, fill out the attached form. You may submit this by fax at 319-863-3963, email at ROI@wchc.org, or by mail at:

400 East Polk Street, PO Box 909
Washington, Iowa 52353

Please note that when emailing to include CONFIDENTIAL or SECURE in your email's subject line.

Medical Information for personal use or for another provider	Submit Online Release of Information	Print & Send Release of Information
Medical Records for WCHC from another organization	Submit Online Release of Information	Print & Send Release of Information