THE UNIVERSITY OF TEXAS MEDICAL BRANCH

RELEASE OF INFORMATION SERVICES

HEALTH INFORMATION MANAGEMENT

IN ACCORDANCE WITH Health and Safety Code, Chapter 241 154(e), THE FOLLOWING FEES HAVE BEEN ESTABLISHED FOR RELEASE OF MEDICAL RECORDS TO MOST REQUESTORS, WITH THE EXCEPTION OF PATIENTS:

$40.06 Retrieval or processing fee, which includes providing the first 10 pages of records

PLUS $1.35 per page for the 11^th through 60^th page

.67 per page for the 61^st through the 400^th page

.35 per page for any remaining pages

PLUS Postage

OR

$61.03 Retrieval or processing fee for records stored on any microform or other electronic medium which includes providing the first 10 pages.

$ 1.35 per page thereafter

PLUS Postage

IN ACCORDANCE WITH THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996, THE FOLLOWING FEES HAVE BEEN ESTABLISHED FOR THE RELEASE OF MEDICAL REORDS TO PATIENTS:

$.10 (10 CENTS) per page

PLUS Postage

SPECIALIZED FEES INCLUDE:

$5.00 for completing insurance forms (including disability insurance forms)

$6.00 Preparation and notary fee for affidavit ($1 prep fee and $5 notary fee)

$18.00 Preparation and notary fee for providing a written response to each set of written questions. ($13.00 for response to each set of written questions and $5 notary fee)

$1.00 for state witness fee

$40.00 for federal witness fee

c;ROI/fees