Forms

Authorization to Release Medical Information Form(s)  - Individuals who would like to request copies of medical records from the Student Health Center, OR have staff request medical records be sent to the Student Health Center, must complete the appropriate form. All requests should include a copy of a photo ID (ie. Driver’s license or Student ID).

• Request Medical Records
  Please complete this form if you need the Health Information Management Staff to send your records to another provider; OR to request records be sent to you or to someone other than a medical provider.
• NOTE:  The SHC creates and receives Protected Health Information (PHI) for our patients and it may be disclosed electronically with patient authorization or when required by law. Electronic disclosures of PHI are sent securely using TXST approved encryption technology.

Concerns with accessing your medical records can be reported to the:

1. SHC Patient Advocate
2. Texas Medical Board, call 512.305.7030 or visit
3. Texas Attorney General