10 hours ago 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 ... >> Go To The Portal
Print the form: 2. Return completed form: 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
Hospital form: Fax to: 515-633-3851, or mail: Attn: Medical Records, MercyOne Des Moines Medical Center, 1111 6th Avenue, Des Moines, IA 50314 Please note -- include the patient’s signature and date of signature, located at the bottom of the form.
It connects to your hospital and clinic to keep your online records up to date. How can I access my Patient Portal? When you are on the MercyOne.org website, find the black "My Home Location" bar at the top of any page and select your home MercyOne location from the dropdown menu.
In addition to online scheduling, MercyOne allows you to check-in online ahead of time. You can confirm your appointment via text message or email, and check-in online prior to your visit. You can also check-in on your own device when you arrive. Mobile registration will make your next visit simpler and faster!
The CHI My CancerCare patient portal gives you online access to your radiation oncology medical records. With this access, you can:
Please note that it may take up to 2 business days to receive confirmation of your appointment and prescription request.
To request a copy of your medical records for MercyOne Des Moines, MercyOne West Des Moines or MercyOne Central Iowa Clinics, follow the steps below.
Please print and complete prior to your visit. To protect your personal information please DO NOT fax or email forms.
During the registration process, you will be asked to sign a General Consent for Treatment form that allows MercyOne to treat you as a patient. Please read this form carefully. The registration staff will be happy to answer questions.
At the time of registration, you will be asked to provide either a current insurance card or information about your current insurance carrier, as well as any specific forms or original documentation (claim forms, authorizations, referrals, etc.) required by your carrier.
MercyOne requests the patient portion of charges be paid at time of registration. The amount varies depending on your insurance coverage. Most policies require patients to pay a deductible and a percentage of the remaining cost of services (co-payments).
Similar to online banking or other secure websites that you use every day, the Patient Portal is an online tool or app for your smartphone or tablet that allows you to manage your health care information anytime, anywhere that is convenient for you. It connects to your hospital and clinic to keep your online records up to date.
When you are on the MercyOne.org website, find the black "My Home Location" bar at the top of any page and select your home MercyOne location from the dropdown menu. Then click the "Patient Portal" button in the top right corner and use your login.
Do not use these tools for urgent medical help. In an emergency, call 911 or your doctor's office to get immediate attention.
Navigate to your Home Location on the MercyOne website and click the Patient Portal for phone and support information for your specific Patient Portal.