Registration & Release of Information

For convenience, complete registration information forms in advance of your visit.

For your convenience, St. Anthony Regional Hospital & Nursing Home wants to provide you with the following forms in advance to make registration process stress-free. Please print the forms, complete your information, and attach any additional documents that may be required and return to St. Anthony.

Birth Place Form

• Baby Registration

Patient Medication

• St. Anthony's Medication Tracking Card

St. Anthony Clinic Form

• Patient Demographics
• Patient Demographics Spanish
• Authorization to Treat a Minor

Provider-Based/Hospital-Based Information

• Provider-Based/Hospital-Based Information Flyer
• Provider-Based/Hospital-Based Information Letter

Release of Information Form

If you need to request copies of your hospital medical records, please CLICK HERE, to complete the form, print it, sign it, and return via fax to (712) 794-5480 or mail to:

Health Information Management
St. Anthony Regional Hospital
PO Box 628
Carroll, IA  51401

Contact by email, click Health Information Management
Contact by phone, call (712) 794-5253

* Please note that St. Anthony Clinic medical records must be requested separately from the clinic.