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Medical Records Release Form

Download a Medical Records Release Form (PDF Reader).

Student Health Services is in compliance with all federal and state guidelines regarding your medical records. Your medical record and the information you share with the doctors or staff is confidential. Requests should be made through:

Patient Services
A. P. Beutel Health Center
Mail Stop 1264
College Station, Texas 77843-1264
(979) 458-8310
(979) 458-8319 Fax
patient-services@shs.tamu.edu    

Processing

If you need to have your records released, Student Health Services, as required by law, must obtain a written release, which allows us to transfer your records. A separate release is required for each transfer.

Student Health Services maintains student Health Information for the mandatory seven years as outlined by Texas A&M University policy. 

As a patient you are entitled to a copy of your records; however, the records are the property of Student Health Services and guidelines are in place to protect you.

Obtain a copy of your Medical Record

This is a two-page form used to request a copy of your health records. Again, we are required to receive your permission before releasing these records. This form must be completed, signed, and returned to us before the release of records can occur. You may mail in your form and payment, fax in your form and be contacted by SHS staff for payment, or complete the form and pay in person.

Please allow up to 14 days for processing.

Cost

Current & Former Student Requests:

Pick up: $1.00 per page (maximum of $15.00) 

Mail: $15.00 

Fax (up to 30 pages): $15.00*  

Mail or Fax (30 or more pages): $25.00

CD for X-Rays: $6.00

Insurance/Legal Requests: $35.00 per request

Priority** $10.00 (added to fee for processing)  

*SHS will ONLY fax a patient's medical records to a doctor's office or another university. 

**Priority means that your request will be placed ahead of all other requests

It is Student Health Services policy to fax records only to another medical provider or university.  All other requests will be mailed or you can pick up in person.