Medical Records Request

How to Request Records

A patient or a patient’s legally authorized representative may request medical records in the following ways:

• Fax: Send a written request to 817-472-3448. A copy of our Authorization Form to release records is available on this page.
• USPS Mail: A copy of our Authorization Form to release records is available on this page. You can complete it and mail it to:

USMD Hospital at Arlington
Health Information Management
801 W. Interstate 20
Arlington, TX 76017

Individuals requesting medical records must present a government-issued photo ID at the time of pickup.

Fees

There is a charge for copies of health care information unless information is provided directly to another health care provider (doctor's office, hospital, etc.)

A basic retrieval or processing fee, which must include the fee for providing the first 10 pages of copies and which may not exceed $30.00.

A charge for each page of:

• $1.00 for the 11th through the 60th page of provided copies
• $0.50 for the 61st through the 400th page of provided copies
• $0.25 for any remaining pages of the provided copies

An additional charge will also apply for the actual cost of mailing, shipping, or otherwise delivering the copies provided.

If the requested records are provided on a digital or other electronic medium and the requesting party requests delivery in a digital or electronic medium, including electronic mail: (A) a retrieval or processing fee, which may not exceed $75.00 in addition to the actual cost of mailing, shipping, or otherwise delivering the provided copies.

Other Charges

USMD Hospital at Arlington may charge a reasonable fee for:

• Execution of an affidavit or certification of a document, not to exceed the charge authorized by Civil Practice and Remedies Code, §22.004; and Written responses to a written set of questions, not to exceed $10.00 for a set.