« Back

Request for PHI

Requests for Protected Health Information (PHI) are processed according to:
 1) presently incarcerated or discharged offenders
 2) deceased offenders

Requests for PHI for offenders presently incarcerated in a TDCJ facility or discharged from a TDCJ facility:
Requests for records established or created during an offender's assignment to a TDCJ facility, can be requested by completing an Authorization for the Use and Disclosure of Protected Health Information from Archives and sending the request in writing to:

Health Services Archives
262 FM 3478 Ste. B
Huntsville, Texas  77320

Please include the following in your requests: Name of offender, date of birth, TDCJ #, copy of a photo ID of the requestor, address and telephone number of the requestor.

An authorization for release of protected health information will be mailed to the requestor to be completed and returned to Health Services Archives. If fees apply, a fee letter will be mailed to the address provided by the requestor. Upon receipt of a money order payable to UTMB-CMC, copies of the requested records will be mailed to the requestor.

For requests for records established or created during an offenders assignment to TDCJ Hospital please fill out an Authorization for Release of PHI and mail to:

UTMB Health Information Management Dept.
Release of Information Team
Galveston, Texas  77555-0782

Requests for PHI for deceased TDCJ offenders:
Please contact the Death Records Technician at (936) 439-1342, or mail a request in writing to:

Health Services Archives
Attn:  Death Records Technician
262 FM 3478 Ste. B
Huntsville, Texas   77320

Upon receipt or notification of request, the requestor will be sent an Affidavit of Personal Representative form.  The form must be completed and notarized and returned prior to any release of protected health information.

 




UTMB's Bold New Brand

 

Celebrate our mission. Celebrate our Vision. Celebrate our brand-new brand. Find out more...