Office phone number: 469-303-2509; Office is open Monday – Friday 8 a.m. – 5 p.m.
Records can be released to anyone who the patient or legal representative authorizes to receive such information. A valid authorization must contain the following information or the request will be returned:
Patient’s full name and date of birth.
Specific information being requested (i.e. type of report/information, dates of service, etc)
Purpose for which information may be disclosed (i.e. inspect health information, obtain a copy of health information)
To whom the information is to be sent (name and address)
Authorization’s expiration date if desired (otherwise the authorization will be valid for 180 days from date signed)
Signature of patient or legal representative
Date of signature
Please make sure the authorization/request is complete to avoid delays. Incomplete requests cannot be processed.