A patient or his/her legal representative may request a copy of his/her medical record, or for a copy to be sent to another party, by completing a Release of Information form. Completion of this form allows UT Physicians to transfer the medical record in compliance with the requirements for protection of patient health care information (HIPAA).
Patients may obtain a copy of the authorization for the use and disclosure of protected health information form by:
- Requesting one from the UT Physicians office in which they received medical care.
- Visiting UT Physicians Health Information Management Department located in the UT Professional Building, Suite LL135, 6410 Fannin St., Houston, TX 77030.
- Calling UT Physicians Health Information Management Department at 832-325-6543.
- Downloading the form below (requires Adobe Acrobat)
(Download the latest version of Adobe Reader free)
There may be a charge for duplication and transfer of a medical record.
In addition, you may also request that records from a previous provider (not affiliated with our medical practice) be forwarded to UT Physicians. Universal Authorization for the Use and Disclosure of Protected Health Information
For additional information, please call UT Physicians Medical Records Department at (832) 325-6543.