Your privacy is very important to us and we protect your medical record information in strict accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). You may obtain copies of your medical records or authorize others to receive copies of your medical record information. Prior to release of medical records, we must receive a written request from the requester and a signed authorization from the patient. The authorization to release information must include the following:
- Drafted to Titus Regional Medical Center
- Name of patient at time of treatment
- Patient date of birth
- Patient social security number
- Specific dates of treatment
- Information requested (history and physical, discharge summary, x-ray film, etc.)
- Purpose of the information being requested
- Name and address of person(s) to receive the information
- Expiration date of the request (unless revoked or stated otherwise, authorization expires in 180 days)
- Signature of the patient, parent if a minor or legal authorized representative
FEES FOR COPIES OF MEDICAL RECORDS
In accordance with Texas State Health and Safety Code, Chapter 241 154(e), we charge the following fees for the retrieval and copy process of medical records:
Copies of paper records:
- 1st 10 pages $35.00
- Pages 11-60 $1.00 per page
- Pages 61-400 $0.50 per page
- Pages 401+ $0.25 per page
- Actual cost of mailing and shipping
Copies of records stored in microfilm or other electronic medium:
- 1st 10 pages $50.00
- Pages 11+ $1.00 per page
- Actual cost of mailing and shipping
Patients presenting in person with valid identification and authorization may receive an accounting of disclosure (a list of who has received your medical record information), and the first six pages of records or x-ray films FREE one time per calendar year. Please call in advance so that we may coordinate a pick-up date and time to better serve you.
For further information, you may contact the TRMC Health Information Management Department:
Release of Information -- 903.577.6137
Privacy Officer -- 903.577.6133 |
