Medical Records
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).
Written Authorization
All requests for the release of medical records (protected health information) must be completed using UTMB Medical Record Form 7032 (Authorization for the Use and Disclosure of Protected Health Information by UTMB). The form must 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. The following information must be provided:
- Patient's name and address
- Patient's date of birth
- Patient's medical records number (UH number)
- Name of person or organization to whom the information is to be disclosed
- Address of person or organization to whom the information is to be disclosed
- Specific health information to be disclosed
- Purpose for release of the information
English and Spanish versions of Form 7032 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.
Submitting An Authorization
Completed authorization forms may be submitted to UTMB by mail or fax.
Mailing address:
University of Texas Medical Branch
Health Information Management
Release of Information Section
301 University Blvd
Galveston, TX 77555-0782Fax number: (409) 772-5101
Processing Fees
A current fee schedule for retrieval/processing 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. Medical record requests for social security disability claims must be accompanied by a supporting letter from the Social Security Administration.
For further information about the release of medical information, contact the UTMB Health Information Management Department at (409) 772-1965.