If you have a Heart of America Medical Center MyHealth login and are requesting records for yourself, you can request records through your MyHealth account. Log in, go to the Messaging tab then click on Non-urgent medical advice then go to General Question and follow the instructions. Within the message box describe which records you would like released and where the records are to be sent.
For all other requests, download and print the Release of Information form below.
Complete the Release of Information form in its entirety.
Sign and date the form. If you need help completing the form, please contact our Medical Records office at the number or email provided.
Once completed, submit the form to the Medical Records office to the address below or requests can be made by email, mail or fax. There may be a charge for copies of your medical records. If there is, we will notify you before copies are made. Once we receive your payment, your request will be processed.
Heart of America Medical Center
Health Information Services
800 South Main Ave.
Rugby, ND 58368
Ph: 701-776-5455 ext. 2257
Fax: 701-776-5448
hamcroi@hamc.com
Release of Information Form (Fillable)