A fee of $10 is charged to patients who request paper copies of their medical records. A fee of $10 is charged to patients who request electronic copies of their medical records. You may select the method to receive your electronic copies, such as via email or on a CD or USB. Should you choose to receive your records on CD or USB, Texas Diabetes & Endocrinology will provide the device. There is no fee to receive one record (a single lab result, office visit note, etc.) via email.
If you need copies of your records, please fill out the Authorization for Release and Disclosure of Protected Health Information. If you are requesting your records to be sent via email, please also complete the Email Consent Form. Our goal is to provide you complete copies of your records in a timely manner. For further information please call (512) 458-8400, option 5 or email firstname.lastname@example.org.
Please be advised that we cannot request your medical records from other offices. We are prohibited by HIPAA to request them unless the request is to the referring doctor. We ask that you contact the office and request that the records be sent to us.
If our office is required to complete an affidavit for medical records, a fee of $15 will be billed to the requesting attorney. For medical record requests by an insurance company, the fee is $25 for the first 20 pages and 50 cents for each page thereafter.
Please complete the forms online at:
Puede encontrar nuestro formulario de liberación médica en español en:
Or you may print a copy at home and fax the completed release to: 512-372-1074.
Printable Medical Records Release of Information