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Requesting Your ARC Medical Records

For Patients

  1. Complete a medical records Release of Information Form:

    A HIPAA-compliant Release of Information Form is required whenever you request copies of your medical record.

    (For your convenience we provide our patient forms online. Please bring the completed form(s) with you to your appointment. The forms below can be filled out in your browser via Adobe Reader or Acrobat, depending on browser type. Note that Adobe Reader cannot save typed data and we suggest printing copies for your records.)
    Authorization for Use or Disclosure from ARC
    Release of Information Instructions
    ARC Release of Information Fee Explanation

  2. Review & pay fees:

    Records delivered electronically:

    • $6.50 flat fee for records that are stored electronically
    • $6.50 flat fee plus $0.07 per page for hybrid records that are stored both electronically and in paper
    • $0.07 per page for records that are stored in paper and scanned 

    Records delivered in paper (actual postage is added to the cost listed below)

    • $0.90 flat fee plus $0.05 per page plus $0.32 (for envelope) for records that are stored electronically
    • $0.90 flat fee plus $0.12 per page plus $0.32 (for envelope) for hybrid records that are stored both electronically and in paper
    • $0.12 per page plus $0.32 (for envelope) for records that are stored in paper

    Here are a few examples of the new pricing:

    • Records stored and delivered electronically (via website/download portal, etc) - the charge will be $6.50
    • Records stored in paper and delivered electronically - the charge would be $0.12 per page ($0.07 per page to scan the record plus $0.05 per page for the paper)
      • ie. The charge for 25 pages will be $3
    • Records stored in paper and delivered in paper - the charge would be $0.12 per page ($0.07 per page to scan the record plus $0.05 per page for the paper) plus $0.32 for the envelope plus actual postage
      • ie. The charge for 25 pages will be $3.32 plus actual postage

    Austin Regional clinic is capping the fee at $25 for a two-year abstract of your medical record including three to six month of diagnostics, regardless of page count.

    If you require your entire record, the fee CIOX Health charges will be according to Texas state statute.  Taxes will be charged if applicable.

  3. Send the completed form to:

    ARC – Release of Information
    9503 Brown Lane
    Bldg 4, Ste 101
    Austin, Texas 78754
    Ph: 512-483-9598
    Fax: 404-855-4977

  4. Send Payment to:

    Via Mail:
    PO Box 409900
    Atlanta, GA 30384

    Via Phone:
    1-770-754-6000

    Via Website:
    paycioxhealth.com/pay/

    If payment in full does not accompany the request, an invoice will be sent within 5 days of receipt of the Authorization to Release Records. Payment can be made by check or credit card. If you have any questions please call us at 512-483-9598 and we will handle your call promptly.

  5. Receive your records by mail or pick them up in person:

    By Mail:
    We will mail your records upon payment in any of the above-mentioned means.

    In Person:
    Please call 512-483-9598 in advance, to eliminate a long wait time.
    Monday - Friday 9:00 a.m. - 4:00 p.m.
    9503 Brown Lane
    Bldg 4, Ste 101
    Austin, TX 78754 

    Please have photo identification available.

For Insurance Companies, Attorneys, APS Services or Disability Services

Please send your request to our Release of Information Processing Center (no prepayment is necessary):

ARC - Release of Information
9503 Brown Lane
Bldg 4, Ste 101
Austin, TX 78754
Ph: 512-483-9598
FAX: 404-855-4977

If you have any questions regarding the process for requesting records and/or associated fees, please contact our Release of Information Processing Center at 512-483-9598.

Requesting Your Medical Records Be Sent to ARC

If you are a new patient establishing care at ARC and will need your medical records transferred from an outside doctor to an ARC doctor, the following form is available for your convenience:

Authorization for Release and Disclosure of PHI to Austin Regional Clinic Form 

Granting Others Access to Your Medical Records

If you would like to grant access to your ARC medical records to your spouse or any other individual(s) for purposes other than treatment, payment, or healthcare operations, please complete the form below.

Please note that the form below can be filled out in your browser via Adobe Reader or Acrobat, depending on browser type. Note that Adobe Reader cannot save typed data and we suggest printing copies for your records.

Authorization for Use and Disclosure of Protected Health Information to a Spouse or Other Individual(s)

Mail the completed form to:

Privacy Officer
Austin Regional Clinic
6210 E. US Highway 290, Suite 120
Austin, TX 78723

Thank you. We look forward to serving you.

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