Release of Medical Information

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 of 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

For further information, you may contact the Health Information Management Department at 903.577.6137 or our Privacy Officer at 903.577.6134