Request for Medical Records

OBTAINING YOUR MEDICAL RECORDS

To receive a copy of your medical records, an authorization to release medical information must be signed and dated by the patient or the patients legal guardian.
Authorization forms can be obtained at any CommUnityCare clinic or you can download the form from this page. See the link below.
The turnaround time to receive copies of health information is 15 business days.
Requestors may be charged a fee to cover the expense for providing copies of health information.
You may deliver the completed request by:
Fax to: (512) 275-2873, or
Drop it off at your CommUnityCare Clinic, or
Mail completed form to:
CommUnityCare
ROI
PO Box 17366
Austin, Texas 78760-7366

Fee Schedule

Exception fee < 10 pages: $1.00 per page; after 10 pages basic retrieval fee applies
Basic Retrieval: $25.00 (up to 20 pages) .50 per page thereafter
Written response to questions: $10.00
Affidavit: $15.00
Dental x-rays: $8.00 each