Medical Records Amendment Request

Mercy Medical Center & Specialty Clinics
Guidelines For Medical Records Amendment Requests

You may request that we amend or correct certain health information that we keep in your or your child's medical records if you believe that it is incorrect or incomplete. All requests for amendments to a medical record must be received in writing using an approved form or via MyChart. If a patient is a minor (less than 18 years of age), a parent or legal guardian must sign the authorization.

As allowed by law, it may take up to 60 to 90 days to complete this process. We are not required to accommodate all amendment requests, but all requests will be thoroughly reviewed. You will receive a written response via U.S. mail once a decision has been made.

Here are the options to request an amendment of your medical records:

• Print a copy of the Request for Amendment of Protected Health Information form and submit the completed form to:

Email: privacy@mercycare.org

Mail:
Mercy Medical Center
Attn: Privacy Officer/Amendment Request
701 10^th St. SE
Cedar Rapids, IA 52403

• Submit an Amendment Request through MyChart. This can be found by going to Menu > My Record > Medical Records Amendment Request. Complete the form and it will be routed directly to the Privacy Officer for processing.
• If you do not have the ability to print the form or to submit your request via MyChart, please contact the Privacy Officer at (319) 398-6846 for further assistance.