All patient health care information at UTMB is confidential. Therefore, medical records cannot be released to any person or organization without the consent of the patient or the patient’s legally authorized representative (unless authorized by law).
Requests for the release of medical records (protected health information) must be submitted in writing and must contain all
the elements required by law. Authorizations must also be dated and signed by the patient or the patient’s legally authorized representative. In the case of a minor, a parent or legal guardian must sign the authorization.
UTMB has an authorization form that can be downloaded.
- English and Spanish versions of this form are available.
(for printing in Adobe Portable Document Format (PDF).
If you do not have the software to view and print this type of document, you can download the plug-in for free from the Adobe Web Site.
Or you may contact the Health Information Management (HIM) Department at (409) 772-1965 and HIM will email or fax the authorization form to you.
Submitting An Authorization
Completed authorization forms may be submitted to UTMB by mail or fax.
University of Texas Medical Branch
Release of Information
301 University Blvd.
Galveston, TX 77555-0782
A current fee schedule for disclosure of health care information is available on the UTMB Health Information Management Web Site.
No fee is assessed when the information is being sent to another health care provider or is for a social security disability
claim. Requests for medical record information for social security disability claims must be accompanied by a supporting letter from the Social Security Administration.
For More Information:
For further information about the release of medical information, contact the UTMB Health Information Management Department
at (409) 772-1965.