Instructions for Completing an Authorization to Release Medical Records
Authorization to Release Medical Records -pdf
Autorización para Divulgar Historial Médicos  -pdf

1. Make sure all blanks have been filled out. An authorization to release medical records is not valid unless all blanks have been completed. Please include the exact clinic that you were seen at in the From Box portion.

2. Be sure you have your identification when you come to pick up records. If you want us to mail your records, be sure to send a copy of your identification in with the request. If someone other than you will be picking up the records, make sure they bring a copy of their identification and they are listed in the “This information is to be released to:” section.

a. Acceptable forms of identification include:
i. Driver’s License
ii. Passport
iii. Work ID
iv. Student ID
v. Military ID
vi. Credit Card/Debit Card
vii. Current Utility/Cell Phone Bill
viii. Birth Certificate
ix. Social Security Card
x. Offender ID
xi. Firearm License
xii. Voter Registration Card
xiii. Any State Issued ID or Foreign ID

3. Read all information on the authorization to release medical records form.

4. There may be fees for records based on the Texas Medical Board rule 165.2.

5. You may fax the completed authorization to release medical records to 512-446-4593.

6. If you have any questions, please contact the Medical Records office at 512-446-4515.