You can transfer care to our facility at any stage of your treatment. All new patients are required to have a diagnostic work up before having a consultation with one of our specialists. The work up includes the following tests: 24 hour urine, echocardiogram/EKG, pulmonary functioning test, blood draw, PET scan/MRI, and a bone marrow biopsy with FISH and cytogenetics.
Please download the consent form to have your medical records released to University of Iowa Hospitals and Clinics.
Important Note: At the top of the form, after you’ve written the patient’s name and birth date, please be sure to fill in the blanks with the name and address of the hospital that has your medical records and not your own name and address. The blanks at the bottom are for the patient or guardian’s name and address.
Choose one of three ways to submit the form after it is completed:
- E-mail the form to firstname.lastname@example.org
- Fax the form to
- Mail the form to:
University of Iowa Hospitals and Clinics
Department of Internal Medicine
C332 General Hospital
200 Hawkins Drive
Iowa City, IA 52242