Release of Information

To request a copy of your medical records please complete the authorization form. Fill the form out as completely as you can. Be sure to include the organization or person along with the address of where you would like your records released. You may print out the form, fill it out, sign and date it and return to Madison Regional Health System by mail or fax. Or you may fill out the PDF and submit via email.

Note: You will need a PDF Viewer such as Adobe Reader to access the PDF document. Release of Information Authorization Form (PDF)

Mail: Madison Regional Health System Attn: Release of Information 323 SW 10th St Madison, SD 57042

Fax: (605) 256-6469 Attn: Release of Information


Requests will be processed in the order it was received.

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