Patient Requests for Medical Record Copies

  1. To request copies of your medical records, print and complete the Authorization for Use and Disclosure of Protected Health Information form below. You may ask questions about releasing your information by calling COIX at (888) 749-7952.
  2. Return your completed form to us via one of the following methods:
    • Mail the completed form to the attention of the Release of Information (R.O.I.) Department to the address on the bottom of the form.
    • Fax the completed form to (469) 484-2006.
    • Drop your completed form off in the Lobby to the Receptionist at Green Oaks Dallas.
  3. Normal processing is 5-7 days for record requests. If request for records is prior to 2007 it may take additional time. If you need your record immediately please write this at the top of the form. All other Medical Records request must be sent by mail to the attention of R.O.I. Department.

Provider & Third Party Requests for Medical Record Copies

Healthcare Providers or other third party requestors, send your request to the address or fax number below. If you need your records immediately, please write this on the top of the form. Normal processing is 5 – 7 days. Please direct questions to COIX at (888) 749-7952.

Please print and complete the form in the link below to obtain a copy of the patient’s medical record.