Patient Requests for Medical Record Copies
- 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.
- Medical Record Release of Information Form – English
- Medical Record Release of Information Form – Spanish
- 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.
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.