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  • To Medical Record Request Form - Texas Child Neurology

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TEXAS CHILD NEUROLOGY, PLLC 1708 COIT RD., SUITE 150 PLANO, TEXAS 75075 972-769-9000 ofc. 972-769-0035 fax AUTHORIZATION FOR RELEASE OF INFORMATION PATIENT NAME: DOB: I certify that I am the Parent.

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Texas law gives a deadline of 15 business days to provide medical records upon receipt of a request and any agreed upon fees. This same deadline also applies if the physician feels it would be harmful to release copies of medical records to a patient.

(1) A licensed physician shall maintain adequate medical records of a patient for a minimum of seven years from the anniversary date of the date of last treatment by the physician....Texas Administrative Code. TITLE 22EXAMINING BOARDSPART 9TEXAS MEDICAL BOARDCHAPTER 165MEDICAL RECORDSRULE §165.1Medical Records

The Knox-Keene Act requires that HMO medical records be maintained for a minimum of two years under Title 28 of the California Code of Regulations (CCR) section 1300.67.

The Texas Medical Privacy Act prohibits any release of PHI for marketing purposes without consent or authorization from the individual. Civil penalties: $100 per violation/day, up to $25,000/year each violation.

The Department of State Health Services is committed to providing full access to public information. To request records under the Texas Public Information Act: Submit a request in writing via U.S. Mail, fax or email. Include contact information and a clear description of the records you are requesting.

The length of time your clinic or hospital is required to hold onto your medical records is called the medical record retention period. Most states' retention periods vary between 5-10 years after the last visit, and after the mandated length of time, your provider is allowed to dispose of your records.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232