Requests for Medical Records | Fees | Exceptions
Other Charges | Addresses and Phone Numbers
Requests for Medical Records
Because an actual signature is required to release medical records information, personnel at Texas Health Resources facilities are not allowed to process requests or authorizations received via e-mail. Please download the Authorization for Release of Patient Information, complete all required fields, sign it, and mail the form to the Medical Records Department of the relevant Texas Health hospital. Addresses for all system hospitals are included on the download form and are also available at the bottom of this page.
Authorization for Release of Patient Information
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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. The following fees are effective at Texas Health hospitals as of Nov. 7, 2012:
| 2012 Fees |
Statute |
| Provided in Paper Form |
1 to 10 pages - $44.35
11 to 60 pages - $1.49 per page
61 to 400 pages - $0.74 per page
More than 400 pages - $0.39 per page |
Health and Safety Code 241 |
| Stored on Microfilm |
1 to 10 pages - $67.57
Subsequent pages - $1.49 per page |
Health and Safety Code 241 |
Stored Digital or Electronic AND
Requested in Digital or Electronic Form |
May not exceed $80.36 |
Health and Safety Code 241 |
| Affidavit or Subpoena |
$1 |
Civil Practice and Remedies Code 22.004 |
| Written Responses |
$10 for a set |
Health and Safety Code 241 |
Provided to Patient (no charge for continuing care)
(If requesting for Disability/Worker's Comp, there is no charge, but patient must show proof of appointment/hearing) |
1 to 10 pages - Complimentary
11 to 50 pages - $0.50 per page
51 or more pages - $0.20 per page |
Texas Health Resources |
| Worker's Compensation |
Initial Fee - $5
1 to 20 pages - $0.50 per page
21 or more pages - $0.30 per page |
TDI - DWC Rules (10/13/08) Chapter 134.5 |
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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.
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Other Charges
The hospital may charge a reasonable fee for:
1. Execution of an affidavit or certification of a document, not to exceed the charge authorized
by Civil Practice and Remedies Code, §22.004; and
2. Written responses to a written set of questions, not to exceed $10.00 for a set.
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Addresses and Phone Numbers
Please mail the requested documentation to the relevant hospital address, listed below. Note that individuals requesting medical records must present a government-issued photo ID at the time of pickup.
|
Texas Health Arlington Memorial Hospital
Health Information Management Department
800 West Randol Mill
Arlington, TX 76012
817-960-6250
Texas Health Harris Methodist Hospital Azle
Health Information Services Department
108 Denver Trail
Azle, TX 76020
817-444-8644
Texas Health Harris Methodist Hospital Cleburne
Health Information Services Department
201 Walls Drive
Cleburne, TX 76031
817-556-4289
Texas Health Harris Methodist Hospital Fort Worth
Health Information Services Department
1301 Pennsylvania Avenue
Fort Worth, TX 76104
817-250-3580
Texas Health Harris Methodist Hospital Hurst-Euless Bedford
Health Information Services Department
1600 Hospital Parkway
Bedford, TX 76022
817-848-4079
Texas Health Harris Methodist Hospital Southwest Fort Worth
Health Information Services Department
6100 Harris Parkway
Fort Worth, TX 76132
817-433-6200
Texas Health Harris Methodist Hospital Stephenville
Health Information Services Department
411 North Belknap
Stephenville, TX 76401
254-965-1538
Texas Health Specialty Hospital Fort Worth
Health Information Services Department
1301 Pennsylvania Avenue
Fort Worth, TX 76104
817-250-3580
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Texas Health Presbyterian Hospital Allen
Health Information Services Department
1105 Central Expressway
Suite 100
Allen, TX 75013
972-747-1000
Texas Health Presbyterian Hospital Dallas
Health Information Services Department
8200 Walnut Hill Lane
Dallas, TX 75231-4402
214-345-7670
Texas Health Presbyterian Hospital Denton
Health Information Services Department
3000 North I-35
Denton, TX 76201
940-898-7176
Texas Health Presbyterian Hospital Kaufman
Health Information Services Department
850 Ed Hall Drive
Kaufman, TX 75142
972-932-7293
Texas Health Presbyterian Hospital Plano
Health Information Services Department
6200 West Parker Rd.
Plano, TX 75093-7914
972-981-8168
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