**If you are an insurance company, attorney, APS service or disability service, please send your request to the clinic where the patient was seen. No prepayment is necessary.**
**For patients, please follow the following procedure in requesting records**
The release of Information form is required whenever you request copies of your medical record. BACTES is Austin Regional Clinic’s medical records Release of Information provider. Texas state statute allows for the following fees for the copying and releasing of medical records in the case of a patient transfer:
Copy of Complete Record First 20 pages: $25.00 Per page after first 20 pages: $.50 Plus any postage costs:
If you require your entire record the fee will be calculated according to Texas State Statute.
Special Rate for 2-year Abstract No page limit, includes postage: $25.00
A 2 year abstract of your medical record includes Problem lists, Med sheets, 2 years of notes and labs and up to 5 years of diagnostics. Regardless of the number of pages, the discounted flat fee for the 2-year abstract is $25.00 including postage.
Please fill out the Authorization for use or Disclosure of Protected Health Information form completely. Mail the completed form along with a check made payable to Bactes at:
Austin Regional Clinic BACTES- ROI- Suite 215 4515 Seton Center Parkway Austin, Texas 78759
If you have requested a 2 year abstract, your record will be sent within 3 days of receipt of the authorization and $25.00 check made payable to Bactes. If you want your complete record, you will be contacted regarding the additional fees per Texas State Statute within three days of receipt of the authorization and $25.00 check made payable to Bactes.
If you have any questions or would prefer to pay by credit card please call us at 512-338-8402 and we will handle your call promptly.
If you are picking up your medical records in person, please call 512-338-8402 in advance, to eliminate a long waiting time. You can pick up records between 9am - 4:pm. Monday - Friday at 4515 Seton Center Parkway, Suite 215.
Thank you. We look forward to serving you.
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Authorization for use or Disclosure of Protected Health Information formExplanation of Fees
