patient medical information release sample letter

#PATIENT MEDICAL INFORMATION RELEASE SAMPLE LETTER FOR FREE#
#PATIENT MEDICAL INFORMATION RELEASE SAMPLE LETTER PORTABLE#

No fee is assessed when the information is being sent to another health care provider or is for a social security disability claim.

Additional information is on the UTMB Health Information Management website. Please allow up to 15 days for the information to be assembled.Ī current fee schedule for release of health care information isĪvailable online. Once written consent has been completed, medical records can be obtained onsite from the following location: Please fax your request to (409) 772-5101.įor all other requesters, please mail your request to: If the patient is in office, has an upcoming appointment or the records are needed for review please indicate this on the request. Or you may contact the Health Information Management (HIM) Department at (409) 772-1965 and HIM will email or fax the authorization form to you.įor UTMB patients requesting records (those not using the online Ciox application), please fax your request to (409) 772-9208 or mail it to the “HIM – Release of Information”įor healthcare facilities requesting records:

#PATIENT MEDICAL INFORMATION RELEASE SAMPLE LETTER FOR FREE#

If you do not have the software to view and print this type of document, you can download the plug-in for free from the Adobe Web Site.

#PATIENT MEDICAL INFORMATION RELEASE SAMPLE LETTER PORTABLE#

These documents are designed to be printed and are offered in Adobe Portable Document Format (PDF).

For all other requests for records please submit the following form: English or Spanish (forms 7032/7032SP).

For patients/parent or guardian needing records, please submit the following form: English or Spanish (forms 7033/7033SP).

In the case of a minor, a parent or legal guardian must sign the authorization.Īuthorization forms can be downloaded from the links below: Authorizations must also be dated and signedīy the patient or the patient’s legally authorized representative.

Written Authorization: Requests for the release of medical records must be submitted in writing (or via the online process outlined above) and must contain all the elements required by law. If you are unable to complete your records request online, records may also be requested by visiting the Health Information Department to fill out an authorization, or mailing/faxing an authorization and request to the HIM Office. ONLINE Medical Record Request - Providers IN PERSON/VIA MAIL Medical Record Request Medical records may be requested via a secure website hosted by Ciox. UTMB has contracted with a partner (Ciox Health) to offer an efficient and convenient process for requesting the release of medical records online. UTMB provides access for patients to significant portions of their medical record-including test and lab results, immunization history, after visit summaries and notes, provider messaging and more-through a patient web portal called UTMB M圜hart.įor medical records not available in M圜hart: ONLINE Medical Record Request

Patient medical information release sample letter