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:
The patient’s name at treatment
Patient’s date of birth
Patient’s Social Security number
The date(s) of treatment
Exact information from the date(s) of treatment
Where the information should be sent
Purpose of request
Sign and date the request
Contact phone number
Copy of photo ID
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 English form by clicking HERE.
For the Spanish translation, click HERE.
Mail your written
Midland Memorial Hospital
ATTN: Medical Records
400 Rosalind Redfern Grover Parkway
Midland, TX 79701
If you need further information regarding the procedure to request copies of records, please call (432) 221-1600.