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Parkland hospital discharge papers

PARKLAND HEALTH & HOSPITAL SYSTEM - Dallas, Texas 2026

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The document is an authorization form for the release of medical information from Parkland Health. It outlines the patient's rights regarding the disclosure of their medical records, including the ability to revoke authorization, potential re-disclosure risks, and specific types of sensitive information that may be included. The form also details patient and recipient information, purpose of the request, format and delivery method options for the records, and includes sections for general medical and imaging records.

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Click ‘Get Form’ to open the PARKLAND HEALTH & HOSPITAL SYSTEM authorization form in the editor.
Begin by filling out the 'Patient Information' section. Enter the patient's name, MRN number, address, date of birth, and contact details accurately.
In the 'Receiving Facility / Individual Information' section, specify who will receive the medical information by providing their name, telephone number, and address.
Select the purpose of your request from the provided options such as legal, personal use, or continuity of patient care.
Choose your preferred format for receiving records (e.g., CD, paper) and indicate your delivery method (fax, mail).
Check all applicable general medical records and imaging/radiology records you wish to request.
Finally, ensure that you sign and date the form at the bottom. If applicable, include interpreter details.

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Versions	Form popularity	Fillable & printable
2022	4.6 Satisfied (44 Votes)
2015	4 Satisfied (43 Votes)

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Is Parkland Hospital closing in Dallas?

Posted: 7/11/2022 Today, officials with Parkland Health closed the doors to the former Parkland Memorial Hospital, thus signifying the start of a 24-month process that will end with the buildings complete removal from the site.

Was Parkland Hospital segregated?

Parkland patient areas were racially segregated until 1964. Prior to that year, there were separate rest rooms, water fountains, elevators and dining facilities for African-Americans and whites.

What hospital is UT Southwestern?

UT Southwestern Medical Center is located in the heart of the Southwestern Medical District a nearly 400-acre medical complex 10 minutes north of downtown Dallas that incorporates UT Southwestern, Childrens Health℠ Childrens Medical Center Dallas, and Parkland Memorial Hospital.

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Is Parkland a free hospital?

Individuals with income below 250 percent of FPIL are eligible to apply for assistance. People who qualify for Parkland Financial Assistance cannot be charged more than the amounts generally billed for emergency or other healthcare that is medically necessary. You can read the full Parkland Financial Assistance Policy.

Is UT Southwestern affiliated with UT?

UT Southwestern is governed by the UT System Board of Regents. The Medical Center includes four degree-granting institutions/schools: UT Southwestern Medical School, UT Southwestern Graduate School of Biomedical Sciences, UT Southwestern School of Health Professions, and UT Southwestern Peter ODonnell Jr.

What is UT Southwestern medical school called?

The Board of Regents accepted this offer from the Foundation, and in 1949 the college became Southwestern Medical School of The University of Texas. In 1954 the name was changed to The University of Texas Southwestern Medical School.

Is UTSW a part of Parkland?

Parkland is UT Southwesterns primary teaching facility.

Is Parkland and UT Southwestern the same?

Parkland Memorial Hospital is the primary teaching hospital for UT Southwestern. More than half of the doctors practicing in Dallas County received some or all of their training at Parkland and UT Southwestern. Parklands Level I Trauma Center and Burn Center are internationally recognized.

PARKLAND HEALTH & HOSPITAL SYSTEM - Dallas, Texas 2026

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