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Contact Us

Texas Health Resources Health Information Exchange
612 E. Lamar Blvd.
Arlington, TX 76011


Patients who no longer wish to participate in the Health Information Exchange may request to revoke access to their personal health information. To revoke access, please complete the form below and click the Submit button. All revocations are typically handled within 24 to 72 hours from notification. You may also print the revocation form, sign and mail for processing.


An audit of users that have accessed your record within the Texas Health HIE can be requested. To request an audit report, please complete the form below and click the Submit button. You may also print the Audit Request Form, sign and mail for processing. All audits will be processed within 21 days of request.



* Indicates required information
First Name * 
Last Name * 
Email Address * 
Date of Birth (MM/DD/YYYY) 
ZIP Code * 
Phone Number * 
Reason for Request * 
Comments 
Do not include any personal health information or personal identification information not specifically requested in the form. 
Authentication * 

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