Health Information Management Phone (760) 323 6289; Fax (760) 323 6201-2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the Patient Name and MRN in the designated fields at the top of the form.
  3. Fill in the Date of Birth by selecting the month, day, and year from the dropdown menus.
  4. In the 'I AUTHORIZE' section, specify both the name of the person or facility releasing information and the recipient's details.
  5. Indicate which specific health information you wish to release by checking the appropriate boxes.
  6. Specify any date or time periods for the requested information in the provided space.
  7. State your purpose for this release by checking one of the options provided.
  8. Initial where indicated to confirm understanding of your rights regarding this authorization.
  9. Finally, sign and date at the bottom of the form, ensuring all required fields are completed before submission.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
Check their website: Information about how to get your health record may be found under the Contact Us section of a providers website. It may direct you to an online portal, a phone number, an email address, or a form. Phone or visit: You can also call or visit your provider and ask them how to get your health record.
Phone Directory Department namePhone number Main Phone 469.764.8000 Business Office/Billing Questions 214.820.2278 Medical Records 469.764.9110 | Fax: 469.764.9118 Physician Referral 1.844.BSW.DOCS (1.844.279.3627) (1.844.279.3627)2 more rows
You may have to fill out a form called a health or medical record release form, or request for accesssend an email, or mail or fax a letter to your provider. But a provider cannot impose unreasonable barriers to your access, or unreasonably delay you from getting your records.
If your provider has a designated medical records department, contact them directly. Provide any reference numbers, confirmations, or details you received when submitting your request. It will help your provider quickly locate your file.
Physicians will require a patient to sign a records release form to transfer records. If you have followed the requirements outlined in the Health Safety Code and the physician has not complied with your request, you may file a complaint with the Medical Board. Please include a copy of your written request(s).