Hospital form: Fax to: 515-633-3851, or mail: Attn: Medical Records, MercyOne Des Moines Medical Center, 1111 6th Avenue, Des Moines, IA 50314. Clinic form: Fax to: 515-358-6996, or mail: MercyOne Central Iowa Clinics Administration, 405 SW 5th Street, Suite F, Des Moines, IA 50309. Please note -- include the patient’s signature and date of ....