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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 of Protected Health Information Form 
    ARC Release of Information Fee Explanation
    Autorización para el uso ó Revelación de Información Protegida sobre su Salud

  2. Review & pay fees:

    A flat fee of $6.50 per patient request, plus:

    • $0.02 per page for records that are stored in paper and scanned
    • $0.05 per page for records that are printed and delivered in hard copy
    • Actual postage for records that are delivered in hard copy (not to exceed $15)

    Here are a few examples of the new pricing:

    • Records stored and delivered electronically (CD, USB, website/download portal, etc) - the charge will be $6.50
    • Records stored in paper and delivered electronically - the charge would be $6.50 plus $0.02 per page to scan the record (ie. The charge for 25 pages will be $7)
    • Records stored in paper and delivered in paper - the charge would be $6.50 plus $0.02 per page to scan the record plus $0.05 per page for the paper plus actual postage (ie. The charge for 25 pages will be $8.25)

    Austin Regional Clinic is capping the fee at $25 for a two-year abstract of your medical record including up to five years of diagnostics regardless of page count.

    If you require your entire record, the fee will be according to Texas state statute.

  3. Send the completed form to:

    ARC – Release of Information
    6937 N IH 35
    Ste 500
    Austin, Texas 78752
    Ph: 770-810-8908
    Fax: 404-855-4977

  4. Send Payment to:

    Via Mail:
    PO Box 409900
    Atlanta, GA 30384

    Via Phone:
    1-770-360-1700

    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 770-810-8908 and we will handle your call promptly.

  5. Receive you 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 770-810-8908 in advance, to eliminate a long wait time.
    Monday - Friday 9:00 a.m. - 4:00 p.m.
    6937 N IH 35
    Ste. 500
    Austin, TX 78752

    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
6937 N IH 35
Ste. 500
Austin, TX 78752
FAX: 512-380-9833

If you have any questions regarding the process for requesting records and/or associated fees, please contact our Release of Information Processing Center at 770-810-8908.

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 
Autorización para Revelación y Declaración de Informatcion Protegia de Salud de Austin Regional Clinic

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
4515 Seton Center Parkway, Suite 215
Austin, TX 78759

Thank you. We look forward to serving you.

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