Request Medical Records

Copy of Paper Medical Records

To request a copy of your medical records for health care received by Dallas County Hospital, please follow the steps below.

1. Print the Authorization for Access, Use or Disclosure of Protected Health Information form in English (pdf).

2. Fully complete the authorization form.  Patient must sign and date the form, if patient is a minor form must be signed by parent/guardian and the records will be sent to the address on file. If the patient is unable to sign, please provide legal documentation needed; ie., Guardianship, to prevent any delays in retrieving the records.

3. There may be a charge, up to but not exceeding $6.50 for Medical Records.

4.. Send all documentation required to the Dallas County Hospital Medical Records department by fax at (515) 465-7670:

Attn: Medical Records


Dallas County Hospital


610 Tenth St.


Perry, IA 50220

With questions, please call the Dallas County Hospital Medical Records department at (515) 465-3547.

DCH Family Medicine Clinics Records

To request clinic records, please contact your clinic directly. Our Medical Records department does not have access to that information.