Request Medical Records

Please download the Authorization for Release of Patient Information, below, complete all required fields, sign it, and mail the form to:

Texas Health Resources
Health Information Management Department
Release of Information
500 E. Border Street, Suite 700
Arlington, TX 76010

Authorization for Release of Patient Information

Autorización de Divulgación de la Información del Paciente

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Fees

The Texas Legislature sets the fees our hospital charges for copies of medical records. This is found in S241.154(e) of the Health and Safety Code. These charges are reviewed and updated annually based on the price index as published by the Bureau of Labor Statistics of the United States Department of Labor.

Exceptions

Local, state or federal agencies requesting health care information may be entitled by statute to a different fee. The agency should inform the hospital of this fact, or information can be obtained from the Legal Department.

Other Charges

  1. Postage fees may apply to requests that are mailed
  2. Execution of an affidavit or certification of a document, not to exceed the charge authorized by Civil Practice and Remedies Code, §22.004

Addresses and Phone Numbers

Please mail all requests for medical records to:

Texas Health Resources
Health Information Management Department
Release of Information
500 E. Border Street, Suite 700
Arlington, TX 76010

Phone: 1-855-681-8243
Fax: 214-345-8811