Medical Record Request Rules for Texas

Introduction

Texas law grants patients substantial control over their medical records, but the process of obtaining those records involves specific procedures, deadlines, and fees that differ from federal minimums. The Texas Health and Safety Code, particularly Chapter 181 and the Texas Medical Records Privacy Act, establishes the framework governing medical record request rules for Texas residents. Understanding these state-specific requirements matters because providers who violate them face penalties, and patients who know the rules can hold facilities accountable when requests stall or fees exceed legal limits.

The Texas Medical Board and the Texas Department of State Health Services oversee compliance, though enforcement often requires patient initiative. Requests can fail for procedural reasons: incomplete authorization forms, unclear descriptions of records sought, or submission to the wrong department within a healthcare organization. Knowing the correct process from the start prevents delays that can impact insurance appeals, legal proceedings, or continuity of care when switching providers.

TL;DR

Texas patients can request their medical records in writing, and providers must respond within 15 business days. Fees are capped by state law: $25 for the first 20 pages, plus $0.50 per page thereafter, with additional charges for electronic delivery or certification. Providers may deny requests under limited circumstances, including records related to psychiatric treatment or ongoing litigation. Authorized representatives can request records on behalf of patients with proper documentation.

Who Can Request Medical Records in Texas

Texas law permits several categories of individuals to access medical records. The patient holds primary rights, but authorized representatives, legal guardians, and parents of minor children also qualify. For deceased patients, the executor or administrator of the estate, or a surviving spouse or adult child, may submit requests.

Third parties require written authorization from the patient specifying what records to release and to whom. This authorization must include the patient's signature, the date, a description of the information to be disclosed, and the identity of the recipient. Authorizations remain valid until the patient revokes them or until a specified expiration date, though providers may refuse authorizations older than 180 days.

Healthcare providers themselves can access records for treatment purposes without patient authorization under the treatment, payment, and healthcare operations exceptions established by both HIPAA and Texas law.

How to Submit a Medical Record Request in Texas

Written requests are required under Texas law. While some facilities accept verbal requests for immediate clinical needs, formal requests for copies must be in writing. Most healthcare organizations provide standardized authorization forms, though patients may submit their own written requests if they include all required elements.

A complete request includes:

• Patient's full legal name and date of birth
• Description of records sought, including date ranges
• Format preference for delivery
• Signature and date
• Recipient's name and address if records go to a third party

Requests should be directed to the medical records department or health information management office. Submitting to a physician's office rather than the hospital's central records department can cause routing delays. Certified mail with return receipt provides proof of submission date, which matters if disputes arise about response timelines.

Response Timeframes

Texas mandates a 15-business-day response window from receipt of a valid written request. This deadline applies to providing the records or notifying the patient of a denial. The clock starts when the records department receives the request, not when the patient mails it.

Providers may request a 30-day extension under specific circumstances, such as when records are stored off-site or require retrieval from multiple locations. The extension requires written notice to the patient explaining the delay. Without such notice, the original 15-day deadline remains binding.

Emergency requests for treatment purposes follow different protocols. When records are needed to prevent imminent harm, providers must respond within 24 hours. This expedited timeline applies to clinical emergencies, not to patient convenience or administrative urgency.

Fees & Costs

Texas caps medical record fees through a schedule published annually by the Texas Medical Board. The current structure permits:

• $25 for the first 20 pages
• $0.50 for each additional page
• Actual cost of postage or delivery
• $1.00 per page for microfilm or microfiche copies
• Reasonable costs for electronic media if records are stored digitally

Providers cannot charge search or retrieval fees separate from the per-page costs. They may require payment before releasing records, but they cannot refuse to process a request while awaiting payment: they must complete the work within the 15-day window and then condition release on payment.

For records requested by other healthcare providers for treatment purposes, fees are limited to actual costs. Patients transferring care should have their new provider request records directly to avoid higher patient-rate fees.

Delivery Formats

Patients may specify their preferred format, and providers must accommodate reasonable requests. Options include paper copies, electronic files on CD or USB drive, or transmission through secure electronic portals. Texas law requires providers to furnish records in the format requested if they maintain records in that format.

Electronic delivery through patient portals has become standard for facilities using certified EHR systems. These portals typically provide access to clinical summaries, lab results, and imaging reports, though complete records including physician notes may require a formal request.

When providers cannot accommodate a specific format, they must offer an alternative that meets the patient's underlying need. A provider who maintains only paper records, for example, cannot be forced to create electronic copies, but must provide legible paper copies or scanned images.

State-Specific Exceptions or Gotchas

Texas includes several provisions that catch patients off guard. Psychotherapy notes receive special protection and require separate authorization beyond a general medical records release. Providers may deny access to these notes even to the patient if disclosure would harm the patient's mental health.

Records related to substance abuse treatment at federally assisted programs fall under 42 CFR Part 2, which imposes stricter requirements than state law. These records require specific consent language and cannot be redisclosed without additional authorization.

Minors in Texas gain certain privacy rights at age 16 for records related to mental health treatment and at any age for reproductive health services. Parents may not automatically access these records even though they remain the minor's legal guardian.

Providers may deny access when records are subject to ongoing litigation or when an attorney has placed a legal hold on the file. Patients involved in malpractice claims or personal injury cases should anticipate this complication.

Common Problems Patients Encounter

Incomplete requests generate the most delays. Facilities reject requests missing signatures, dates, or adequate descriptions of records sought. Patients requesting "all records" may receive only recent visits unless they specify a date range extending back to their first encounter.

Fee disputes arise when providers charge amounts exceeding statutory limits or add prohibited charges for retrieval or administrative processing. Patients should compare invoices against the published fee schedule and dispute overcharges in writing.

Lost requests occur more frequently than facilities acknowledge. Submitting requests via certified mail or through patient portals with delivery confirmation creates documentation if the provider claims never to have received the request.

Portal access limitations frustrate patients expecting complete records. Most portals provide clinical summaries rather than full documentation. Operative reports, pathology findings, and detailed physician notes often require formal requests outside the portal system.

Delays beyond 15 business days without extension notice violate Texas law. Patients may file complaints with the Texas Medical Board or the Office of the Attorney General's Health Care Fraud Unit when providers miss deadlines.

Conclusion

Medical record request rules for Texas establish clear obligations for healthcare providers: 15-business-day response times, capped fees, and format flexibility. Patients who understand these requirements can submit complete requests that minimize delays and identify violations when providers fail to comply. The key to successful requests lies in specificity: naming exact date ranges, identifying the correct department, and documenting submission dates.

When providers miss deadlines or overcharge, formal complaints to the Texas Medical Board create accountability. Most disputes resolve once patients demonstrate knowledge of the applicable rules. For complex situations involving mental health records, substance abuse treatment, or litigation holds, consulting with a health information specialist or attorney may prevent extended delays.

Frequently Asked Questions

Can a provider refuse to release my records? Yes, under limited circumstances. Denial is permitted for psychotherapy notes, records subject to legal holds, or when disclosure would endanger the patient or others. Providers must explain denials in writing and inform patients of appeal rights.

How long must providers retain medical records in Texas? Adult records must be maintained for seven years from the last treatment date. Records of minors must be kept until the patient turns 21 or for seven years from the last treatment, whichever is longer.

Can I request records from a provider who has closed their practice? Closed practices must transfer records to another provider or storage facility and notify patients of the new location. The Texas Medical Board maintains information about record custodians for closed practices.

Sources

• Texas Health and Safety Code, Chapter 181
• Texas Administrative Code, Title 22, Part 9, Chapter 165
• Texas Medical Board Rules on Medical Records
• S. Department of Health and Human Services, HIPAA Privacy Rule
• 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records