Patient Medical Records Request

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Option 1: Patient Pick-Up

Want to pick up your records?

Complete the contact form below.

I would like to pick up my report at*
First Name*
Middle Name*
Last Name*
Email*
Address*
Street Address City ZIP / Postal Code
Patient's Date of Birth*
Date Format: MM slash DD slash YYYY
Daytime Phone*
Mobile Phone
Date of Service*
Date Format: MM slash DD slash YYYY
Study Requested*
In what form do you need the Images/report?*
DISCLAIMER

You are agreeing to the terms of our secure forms and will enter a secure area of our website. Austin Radiological Association will not be held responsible in the event your electronic message is not transmitted due to technical problems related to this site or to the hosting server. All personal identifying information is encrypted and your message will not be internally or externally forwarded to other third parties. The information will solely be used by Austin Radiological Association. Your request will be processed within 24 hours, during normal business hours, Monday – Friday, 9:00 am – 4:30 pm, excluding holidays. If you do not accept the terms of this disclaimer, you will not be able to process your request on-line. If you have any questions regarding the use of these forms, please contact our office during normal business hours.
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- I agree to terms of use
Additional Comments
Please confirm you are a human:

Option 2: Address Deliveries

Need records delivered or mailed?

View and print the Authorization for Release of Medical Records*.

*All files are saved in Adobe pdf format and require Adobe Acrobat Reader to view. Download a free copy of the viewer.

Patient Records Request

How do I request a copy of my Medical Records?

You can request a copy of your Medical Records by completing an Authorization for Release of Medical Records. Because an actual signature is required to release medical records information, personnel at Austin Radiological Association are not allowed to process requests or authorizations received via email.

Who is authorized to sign for release of my health information?

The following people are authorized to sign for release of your health information: The patient (Not the spouse) Power of attorney if the patient is unable to sign (Legal document must be provided.) Parent Parent and minor if the patient is 12 to 17 years of age and receiving psychiatric, alcohol, or drug treatment services Legal guardian (Proof of guardianship document must be provided.) Emancipated Minor (if the patient is 17 or 16 and provides a copy of the court order) Representative of the estate for deceased patients (Copy of the death certificate and a copy of the representative of estate documents must be provided.)

When will I receive a copy of the medical records?

Copies are processed within 24 to 48 hours from the date the Authorization is received. Be advised that requests will not be complete until the Authorization for Release of Medical records form is received. Recipients will be notified if the request cannot be processed within the above time frame.

Who do I contact if I have questions?

If you are a patient and have a question about your request for medical records, you may contact our Image Library department at (512) 719-8230; or you can send an email to [email protected].

How much does it cost to obtain a copy of my health information?

There is no charge for releasing copies of health information directly to other health care providers. The patient will be responsible for any carrier fees except if mailed through regular US Mail.

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