Requesting Your ARC Medical Records
- 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
- 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.
- Send the completed form to:
ARC – Release of Information
6937 N IH35
Austin, Texas 78752
- Send Payment to:
PO Box 409900
Atlanta, GA 30384
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.
- Receive your records by mail or pick them up in person:
We will mail your records upon payment in any of the above-mentioned means.
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
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 IH35
Austin, TX 78752
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:
Austin Regional Clinic
4515 Seton Center Parkway, Suite 215
Austin, TX 78759
Thank you. We look forward to serving you.
Download Adobe Reader to view and print documents.