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Medical Records Access and Release

ACCESSING MY MEDICAL RECORDS VIA THE NORTH CYPRESS MEDICAL CENTER PATIENT PORTAL

North Cypress Medical Center's Patient Portal is a secure, private web portal that allows you to access your health information online - anytime, anytime. Click here to access the Patient Portal.

Release of my Medical Records

The Health Information Management Department is dedicated to safely maintaining your medical records and keeping your health information private. Hours of operation are Monday through Friday, 8 a.m. to 4:30 p.m. We may be contacted for assistance at 832-912-3530.
  • How do I request medical records?
  • Who is authorized to sign for release?
  • How much will it cost?
  • Where do I mail or fax the authorization form?
  • How do I request Imaging Studies?
  • How do I request Billing Statements?
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How Do I Request My Medical Records?

Please download the Authorization for Release of Information form and follow the guidelines for completion.    A valid authorization MUST contain the following information or the request will be returned.
  • Patient's full name (list any other names, such as maiden name, that the patient may have had)
  • Patient's date of birth
  • Name of person/provider/facility the information is to be released to
  • Purpose for which the information is being utilized
  • Date(s) of treatment or services you are requesting
  • Specific information requested
  • Patient's signature or patient's legal representative's signature.   Authorizations signed by a patient representative must have accompanying documentation.   Records will not be released without valid signature(s)/documentation (if applicable).

Requests for Personal Use:

  • Complete and submit the Authorization for Release of Information form.
  • There is a fee for the copies and processing of records for personal use.   Please see the section on cost below.
  • Please allow reasonable time to process your request.   Typical requests are processed within 15 business days of receipt.   We will contact you in the event of unforeseen delays or difficulty processing your request.
  • Records will be mailed to the address specified on the authorization form.

Requests for Continuing Medical Care:

  • Complete and submit the Authorization for Release of Information form, or complete the request form from the physician or other healthcare provider's office.
  • Continuing care requests are free of charge and will be mailed or faxed to your physician/the facility prior to your appointment.   Please indicate the date of your appointment to allow for time to process your request.
  • Pertinent information for continued care such as ER reports, physician reports, laboratory results, radiology/imaging reports, and discharge summaries results are routinely provided to the physician for the continuation of care.
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Who is Authorized to Sign for Release?

A valid signature includes:

  • The patient, if they are 18 years or older
  • The parent or legal guardian, if the patient is younger than 18 years of age
  • A guardian, if the patient has been legally deemed incompetent.   Documentation must be provided to prove guardianship
  • Medical Power of Attorney, in the event the patient is unable to sign.   A copy of the medical power of attorney will be required
  • Requests for medical records of deceased patients require a copy of the death certificate or proof executorship of the estate
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How Much Will It Cost?

The cost is dependent on the type of use.
  • There is no charge for information to be sent from our facility directly to another hospital or physician (continued medical care).   Please make sure to include the physician's name, phone number, and fax number on the authorization form.
  • Patients/requestors (personal use) will be charged in Accordance with the Texas Health and Safety Code 241.154(e).
  • You may request another party request the record on your behalf (i.e. insurance company).
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 Where Do I Mail/Fax the Authorization Form?

Completed Authorization Forms may be mailed or faxed to the following address:

Attn: Health Information Management Department

North Cypress Medical Center

21214 Northwest Freeway

Cypress, TX 77429

Fax:  832-912-3778                                                                                                                                                                                                                                                                              

Email:  To protect our patients' privacy, we don't transmit confidential patient information via e-mail.                                                                                                                                                   

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How Do I Request Imaging Studies?

For a CD of your images to bring to another physician, please contact our Radiology Department At 832-912-3053.

 

How Do I Request Billing Statements?

For a copy of your Bill/Statement, please contact Patient Accounts at 832-912-3722.

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