Patient Medical Records

The Health Information Management Department (HIM) at UTMB is dedicated to maintaining your medical records and keeping your health information private and secure in accordance with federal and state regulations.

Release of Information

For copies of a medical record please contact:
 
The University of Texas Medical Branch
Department of Health Information Management
Release of Information Section
301 University Blvd.
Galveston, Texas 77555-0782
409.772.1965
409.772.5101 (Fax)

Additional information and detailed instructions can be found here.

See Authorization for Release of Information form and Fee Schedule under the General Information tab.

Master Patient Index (MPI/PIDX) Inquiries

For assistance with questions regarding the MPI contact:
 
Master Patient Index Coordinator
409.772.1744
Form # (English)
Form Name
Form # (Spanish)
Disclosure & Consent Medical & Surgical Procedures - Generic
Disclosure & Consent, Medical & Surgical Procedures - Anesthesia
Disclosure & Consent Medical & Surgical Procedures - Cardiovascular System
Disclosure & Consent Medical & Surgical Procedures - Digestive System
Disclosure & Consent Medical & Surgical Procedures - Ear Treatments
Disclosure & Consent Medical & Surgical Procedures - Endocrine System
Disclosure & Consent, Medical & Surgical Procedures - Eye Treatments
Disclosure & Consent, Medical & Surgical Procedures - Hematic & Lymphatic
Disclosure & Consent Medical & Surgical Procedures - Non Cosmetic Breast Surgery
Disclosure & Consent, Medical & Surgical Procedures - Male Genital
Disclosure & Consent, Medical & Surgical Procedures - Male Genital CIRCUMCISION
Disclosure & Consent Medical & Surgical Procedures - Musculoskeletal System
Disclosure & Consent Medical & Surgical Procedures - Nervous System
Disclosure & Consent, Medical & Surgical Procedures - Radiology
Disclosure & Consent, Medical & Surgical Procedures - Respiratory System
Disclosure & Consent, Medical & Surgical Procedures - Urinary System
Disclosure & Consent, Medical & Surgical Procedures - Urinary VALID 1 YR
Disclosure & Consent, Medical & Surgical Procedures - Radiation Therapy
Disclosure & Consent Medical & Surgical Procedures - Endoscopic System
Disclosure & Consent Medical & Surgical Procedures - Hysterectomy
Disclosure & Consent Medical & Surgical Procedures - Maternity/Female Genital
Disclosure & Consent Medical & Surgical Procedures - Maternity/Female Genital PREGNANCY
Disclosure & Consent Medical & Surgical Procedures - Dermatologic Surgery
Disclosure & Consent, Medical & Surgical Procedures - Epilepsy Monitoring
Disclosure & Consent, Medical & Surgical Procedures, Kidney/Pancreas
Disclosure & Consent Medical & Surgical Procedures - Genetic Amniocentesis
Disclosure & Consent Medical & Surgical Procedures - Gastroenterology/Endo
Disclosure & Consent, Medical & Surgical Procedures - Pain Management
Disclosure & Consent, Medical & Surgical Procedures - Ophthalmology
Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology OR
Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Head/Neck OR
Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Sinus OR
Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Voice Proc
Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Ear Procedure
Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Head/Neck Clinic
Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Sinus Clinic
Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Voice Clinic
Disclosure & Consent, Medical & Surgical Procedures - Heart Transplant
Disclosure & Consent Medical & Surgical Procedures - Pedi ENT
Disclosure & Consent Medical & Surgical Procedures - Hyperbaric Oxygen Therapy
Disclosure & Consent Medical & Surgical Procedures - Hyperbaric Oxygenation
Disclosure & Consent Medical & Surgical Procedures - Pulmonary
Disclosure & Consent Medical & Surgical Procedures - Liver Transplant
Disclosure & Consent Medical & Surgical Procedures - Exercise Stress Test
Disclosure & Consent Medical & Surgical Procedures - Ultrasound - MRI Guided Biopsy or Aspiration
Consent to Treatment with Psychoactive Medication
Disclosure & Consent Medical & Surgical Procedures - Blood Transfusion
Disclosure & Consent, Medical & Surgical Procedure - Transfusion of COVID-19 Convalescent Plasma
Disclosure & Consent Medical & Surgical Procedures - Oral and Maxillofacial
Consent to Resuscitative Measures/Transfer
Disclosure & Consent Medical & Surgical Procedures - Dobutamine Stress Echo
Disclosure & Consent Medical & Surgical Procdures - Removal of Nexplanon
Disclosure & Consent for Chemotherapy/Biotherapy Treatments
Disclosure & Consent, Medical & Surgical Procedures - Female Genital Operative Consent (No planned Hysterectomy)
Disclosure & Consent, Medical & Surgical Procedures - Female Genital Office Consent
Disclosure & Consent, Medical & Surgical Procedures - Female Genital IUD INSERTION
Disclosure & Consent, Medical & Surgical Procedures - Female Genital IUD REMOVAL
Disclosure & Consent, Medical & Surgical Procedures - Colorectal Surgery
Disclosure & Consent, Medical & Surgical Procedures - Pathology
Refusal/Consent for Blood Products

For Full E-forms Catalog: https://my.utmb.edu
(For Internal UTMB Use Only)