Medical Records Requests
How do I request a copy of a medical record?
Who is authorized to sign for release of information (get a
copy of a medical record)?
How much does it cost to obtain a copy of a medical record?
When will I receive a copy of the medical record?
Who do I contact if I have questions?
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How do I request a copy of a medical record?
You can request a copy of a medical record by completing an
Authorization to
Release/Exchange Information form and submitting it to the Medical Records
Department. Download and print an Adobe Acrobat PDF file of the Release of
Medical Record form and instructions. You can submit this form to us
by mail or in person.
Who is authorized to sign for release of information (get a copy of a
medical record)?
The following people are authorized to sign for release of information:
 | The consumer/client (Not the spouse.) |
| Power of attorney, if patient is unable to sign (Documentation must be
provided.) |
| Parent (If the consumer/client is under the age of 18.) |
| Parent and minor (If the consumer/client is 12-17 years of age. This is
for records relating to psychiatric, alcohol, or drug treatment services.)
|
| Legal guardian (Proof of guardianship documentation must be provided.)
|
| Representative of the estate for deceased consumer/client (Copy of the
death certificate and a copy of the representative of estate documents must be
provided.) |
How much does it cost to obtain a copy of a medical record?
There is no charge for releasing medical records directly to other healthcare
providers. However, there is a fee assessed for providing records to all other
requesters. This fee includes a processing fee and a page charge. The charges
are as follows:
| Pages 1 - 59
$1.18 per page |
| Pages 60 - 400
$0.59 per page |
When will I receive a copy of the my medical record?
The Medical Records Department receives a large number of requests and many of
the records requested are very complicated. Your request will be processed
within 15 business days.
Who do I contact if I have questions?
If you have any questions, please call the Medical Records Department at:
(940) 720-3516.
Our mailing address is:
Helen Farabee Regional MHMR Centers
Medical Records Department
516 Denver
Wichita Falls, TX 76301
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