Request for medical records form - Des Moines University - dmu 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name and address in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the date of birth, city, state, and zip code. This helps verify the patient's identity and ensures proper record retrieval.
4. Indicate whether you want to send or obtain medical records by checking the appropriate box. If obtaining records, provide the name and address of the entity from which you are requesting them.
5. Select which medical information you wish to release by checking the relevant boxes such as progress notes, lab results, or immunizations.
6. Specify the reason for the release of information by checking one of the options provided or writing your own if necessary.
7. Sign and date the form at the bottom to authorize the release of your medical records. Make sure to include any specific authorizations if applicable.

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