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 Pioneer Memorial Hospital & Health Services by mail or fax. Or you may fill out the PDF and submit via email.

Release of Information Authorization Form

Mail: Pioneer Memorial Hospital & Health Services Attn: Release of Information 315 N. Washington St. Viborg, SD 57070

Fax: (605) 326-1168 Attn: Release of Information

Requests will be processed in the order it was received

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