Medical Records

Instructions:

• Patients (or their parents/legally authorized representative) who want to see or obtain a copy of their medical records must complete a Request for Action Concerning Protected Health Information form. You may also pick up a copy of this form from a medical records staff at any CHCS clinic. This form must be filled out completely and signed or the processing of your request may be delayed. Any information such as deadlines, attorney information, special instructions, etc. must be written on the form and copies of supporting documents attached.
• Include a copy of your driver’s license or some other form of photo identification (ID) with the request form.
• If requesting records for a person who is deceased, we require a copy of the death certificate.
• If you are not the patient, we require written documentation of your authority to sign the request form and to obtain copies of the patient’s medical/health information.
• Once completed, you may fax or mail the request form with supporting documents to:
  The Center For Health Care Services
  Attn: Release of Information Dept.
  6800 Park Ten Blvd., Suite 200-S
  San Antonio, Texas 78213
  Office Number: (210) 261-1074
  Fax Number: (210) 261-1817

If you would like to call to check the status of your request, you may call (210) 261-1074. You should be contacted either by mail or phone within 3-5 business days of receipt of your request.

A fee may apply to your request. The amount of the fee cannot be determined until your request has been received. You will be notified of the amount. If you have any questions about fees for medical records, you may call (210) 261-1074.

If you have any other questions about requesting medical records, call (210) 261-1074. Please leave a detailed message including a phone number to return your call.

We ask that you not ‘walk–in’ to check status, make payment or pick up records.

Instructions:

• Patients (or their parents/legally authorized representative) who want to have a copy of their medical records sent to someone else must complete an Authorization for Disclosure, Use, or Receipt of Protected Health Information form. You may also pick up a copy of this form from a medical records staff at any CHCS clinic. This form must be filled out completely and signed or the processing of your request may be delayed. Any information such as deadlines, attorney information, special instructions, etc. must be written on the form and copies of supporting documents attached.
• Include a copy of your driver’s license or some other form of photo identification (ID) with the authorization form.
• If requesting that records of a person who is deceased be sent to someone else, we require a copy of the death certificate.
• If you are not the patient, we require written documentation of your authority to sign the authorization form and obtain copies of the patient’s medical/health information.
• Once completed, you may fax or mail the authorization form with supporting documents to:
  The Center For Health Care Services
  Attn.: Release of Information Dept.
  6800 Park Ten Blvd., Suite 200-S
  San Antonio, Texas 78213
  Office Number: (210) 261-1074
  Fax Number: (210) 261-1817

If you would like to call to check the status of your request, you may call (210) 261-1074. You should be contacted either by mail or phone within 3-5 business days of receipt of your request.

A fee may apply to your request. The amount of the fee cannot be determined until your request has been received. You will be notified of the amount. There is no charge for records being sent directly to another healthcare facility or physician for continuation of care. If you have any questions about fees for medical records, you may call (210) 261-1074.

If you have any other questions about requesting medical records, call (210) 261-1074. Please leave a detailed message including a phone number to return your call.

We ask that you not ‘walk –in’ to check status, make payment or pick up records.

• Request for Action Concerning Protected Health Information | Download
• Pedido de Acción en Relación con la Información de Salud Protegida  | Descargar
• Authorization for Disclosure, Use, or Receipt of Protected Health Information Form | Download

• Autorización Para Divulgar, Usar, 0 Recibir Información de Salud Protegida| Descargar