Services Medical Records

Instructions:

• Individuals (or their parents/legally authorized guardians) who wish to view or obtain a copy of their medical records must complete a Request for Access to Protected Health Information form. You may also pick up a copy of this form at any BRBHC location. This form must be completed completely and signed or the processing of your application may be delayed. Any information, such as deadlines, attorney information, special instructions, etc., should be written on the form and copies of supporting documents attached.
• Include a copy of your driver's license or some other form of photo identification (ID) with the application form.
• If you are requesting records of a deceased person, we require a copy of the death certificate.
• If you are not the patient, we require written documentation from your authority to sign the request form and obtain copies of the patient's medical/health information.
• Once completed, you may fax, mail, or email the application form with supporting documents to:
Border Region Behavioral Health Center
Attn: Medical Records Department
1500 Pappas Street Laredo, Texas 78041
Office Number: 956-794-3278
Fax: 956-794-3176
Email: recordsrequest@borderregion.org

If you would like to call to check the status of your application, you can call (956) 794-3278. You will be contacted by phone within 7-10 business days of receiving your request.

A fee may apply to your request. The amount of the fee cannot be determined until your request has been received. You will be notified of the amount. If you have any questions about medical record fees, you can call (956) 794-3278.

If you have any other questions about requesting medical records, please call (956) 794-3278. Leave a detailed message that includes a phone number to call you back.

We ask that you do not "walk in" to check the status.

Instructions:

• Individuals (or their parents/legally authorized guardians) who wish to release records or request records to be sent to must complete a Confidential Release of Information form. You may also pick up a copy of this form at any BRBHC location. This form must be completed completely and signed or the processing of your application may be delayed. Any information, such as deadlines, attorney information, special instructions, etc., should be written on the form and copies of supporting documents attached.
• Include a copy of your driver's license or some other form of photo identification (ID) with the application form.
• If you are requesting records of a deceased person, we require a copy of the death certificate.
• If you are not the patient, we require written documentation from your authority to sign the request form and obtain copies of the patient's medical/health information.
• Once completed, you may fax, mail, or email the application form with supporting documents to:
Border Region Behavioral Health Center
Attn: Medical Records Department
1500 Pappas Street Laredo, Texas 78041
Office Number: 956-794-3278
Fax: 956-794-3176
Email: recordsrequest@borderregion.org

If you would like to call to check the status of your application, you can call (956) 794-3278. You will be contacted by phone within 7-10 business days of receiving your request.

A fee may apply to your request. The amount of the fee cannot be determined until your request has been received. You will be notified of the amount. If you have any questions about medical record fees, you can call (956) 794-3278.

If you have any other questions about requesting medical records, please call (956) 794-3278. Leave a detailed message that includes a phone number to call you back.

We ask that you do not "walk in" to check the status.

- Request for Access to Protected Health Information
 o English
 o Spanish

- Confidential Disclosure of Information
 o English
 o Spanish

• Is there a fee for forms?
 Yes, any form that requires a provider’s signature has a fee of $20.00.
• Is there a fee for letters?
 Yes, any letter that is made by medical records, or if a letter requires a provider’s signature, there is a fee of $2.00.
• Is there a fee for medical records?
 Yes, for any request for records that is over 25 pages, there is a fee of $35.00 for the documents.
• Can signed forms be faxed?
 Yes, as soon as the fee has been processed for the form, Medical Records will fax the form.
• Do I have to pay for a copy of a signed form?
 No, once a form fee has been paid there won’t be any additional charges.
• Do I need authorization for disclosure (release of information) for medical releases, letters, forms?
 Yes, an authorization for disclosure must be completed in the system before we can release any information.
• Do I need separate authorizations for schools or other organizations and individual/parent?
 Yes, there must be individual authorizations before information can be released.
• Do I need individual authorizations for family members?
 Yes, individual authorizations must be completed for every member of the family/individual who will have access to an individual’s information.