Requests for Medical Records

Genesis protects the confidentiality of your medical records, while providing you or your authorized representative access when you need them. Also known as Protected Health Information (PHI), your medical records are available to you on paper or CD. If the copy of your medical records is for your own personal use, there is a minimum $20 fee for processing. There is no charge to send your medical records to another health care provider outside of Genesis for continuity of care, or to your insurance company if requested.

Below is information on how you can request copies of your medical records, depending on the type of information you need. If you still have questions, contact the Genesis Health Information Management (HIM) office at (563) 421-7260.

Hospital | Physician Office | Radiology

Hospital Medical Records

To request a copy of your hospital medical records for yourself, print and complete the Authorization for Use and Disclosure of Protected Health Information form, then:

  • Bring the completed form to the Genesis HIM office, located at 3390 Utica Ridge Rd., Bettendorf. A short wait will be required while we process your request.
  • OR mail the completed form to the HIM office:
    Genesis Health Information Management
    3390 Utica Ridge Rd.
    Bettendorf, Iowa 52722
  • Requests received by mail will be processed within three working days. You must pick up your medical records copy in person and present a photo ID for verification. The HIM office is open Monday through Friday, from 8 a.m. to 4:30 p.m.

If you need your hospital medical records sent to another health care provider outside of Genesis for continuity of care, or to an insurance company for determination of eligibility/coverage, or review of health care services with respect to medical necessity, coverage under a health plan, appropriateness of care, or justification of charges, completion of the authorization form is not necessary. Simply call the HIM office at (563) 421-7260 to direct where your records should be sent.

Physician Office Medical Records

To request a copy of your physician office medical records for yourself, or to have them sent to another health care provider outside of Genesis for continuity of care, or to your insurance company, print and complete the Authorization for Use and Disclosure of Protected Health Information form.

  • Bring the completed form in person to your physician’s office.
  • You must present a photo ID for verification.
  • If the requested medical records are for personal use, your copy will be mailed to you.
  • If the requested medical records are for another health care provider outside of Genesis, or for an insurance company, provide the necessary information and Genesis will take care of sending the copy as directed.
  • Please allow two business days to complete your request.

Check with your physician’s office for business hours, or if you have any questions.

How Much Will It Cost?

There is a charge to cover clerical and other administrative expenses related to complying with the request for medical records:

  • $20 for 1 to 20 pages
  • $20 plus $1 per page for pages 21-30 copied
  • $30 plus $0.50 per page for pages 31-100 copied
  • $65 plus $0.25 per page for pages 101-200 copied
  • $90 plus $0.10 per page for pages 201 and above copied

There is no charge if the records are being sent directly to another health care facility/provider to maintain continuity of care, or to an insurance company for determination of eligibility/coverage, review of appropriateness of care or justification of charges, etc.

Requesting Other Types of Records

Radiology Images or Imaging Films

We can provide you with a CD that contains your imaging study (the images obtained by X-Ray, MRI, CT, etc.) and/or the report prepared by the Radiologist who has analyzed it.

  • The copy of your imaging study (images) can only be picked up by coming to one of our hospital imaging departments or outpatient imaging centers listed below.
  • Request your copy in person or call ahead. If you do not call ahead, a short wait will be required while we process your request.
  • The imaging departments/centers can ONLY provide a copy of your images.
  • The Genesis HIM office cannot provide a copy of your images.
  • The HIM office can provide a copy of the Radiologist’s report.
  • You must show identification and complete and sign the Authorization for Use and Disclosure of Protected Health Information form.
  • There is no cost.

GMC-East Rusholme Street Imaging – (563) 421-6160
GMC-West Central Park Imaging – (563) 421-1160
GMC-Silvis Imaging – (309) 281-4140
GMC-Aledo Imaging – (309) 582-9140
GMC-DeWitt Imaging – (563) 659-4270
53rd Street Imaging Center, Davenport – (563) 421-9729
Bettendorf Imaging Center – (563) 421-3760
Moline Imaging Center – (309) 281-6260

Questions about all other medical information/tests/records should be directed to the HIM office at (563) 421-7260.

Other Information You May Need to Know

If you are requesting records for a patient who lacks legal capacity or is unable to sign, an authorized personal representative may sign the Authorization for Use and Disclosure of Protected Health Information form. Written proof of authority should accompany the request in order to verify appropriate health information access for the following:

  • Court-appointed guardian or other legally appointed representative
  • Executor/administrator/attorney in fact
  • Affidavit next-of-kin
  • Power of Attorney

Verification of identity is required. Fees may apply. If you have questions, call the HIM office at (563) 421-7260.

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Questions about your Medical Record? Call 563-421-7260.