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The purpose of Release of Information is to provide copies of patient records to various requesters (i.e. patients, attorneys, insurance companies, etc.) for varied reasons.

When writing to obtain copies of records, please provide us with the following information:
  1. The patient name at treatment
  2. Patient's date of birth
  3. Patient's Social Security number
  4. The date(s) of treatment
  5. Exact information from the date(s) of treatment
  6. Where the information should be sent
  7. Purpose of request
  8. Sign and date the request

Please do not send requests for information or confidential information via e-mail. We cannot honor e-mail requests because a signature is required to release medical information.

The Release of Information will not provide records without a written request by the patient, the parent of a minor patient, or a legal representative. After the request is received, Release of Information should provide an answer in 15 working days. Copies of records are faxed only for emergency medical treatment (i.e. patient is in the Emergency Room or in Labor & Delivery).

There are fees to obtain copies of records. These fees must be paid prior to records being mailed to the requester. When a request is received, Release of Information will send the requester an invoice stating the fee for copies. The fees for copying records are set by the State of Texas and are reviewed for changes annually.

Download the form here and mail your written request to:

Release of Information
Parkland Memorial Hospital
5201 Harry Hines Blvd.
Dallas, TX 75235

If you need further information regarding the procedure to request copies of records, please call 214.590.5470.

Amendment Requests

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) grants individuals the right to request an amendment to their protected health information if they feel their health record contains information that is factually incorrect or incomplete. Please download the form below and mail it to the enclosed address to request an amendment.

Amendment Request Form (English)

Amendment Request Form (EspaƱol)

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