Children’s Urology cannot see patients without their referring provider’s medical records on file in our office. Please ensure that your referring physician has provided us with all the pertinent medical records prior to your scheduled appointment or else you may be asked to reschedule. Fax records to 512-472-2928.
Children’s Urology abides by federal HIPAA guidelines, in that all patient care information is strictly confidential and will not be released to any person or organization without the consent of the patient or the patient’s legally authorized representative (unless authorized by law). This includes verbal information.
To receive a copy of your child’s medical health information, an authorized release of medical information must be signed and dated by the parent or legal guardian.
Requests for medical information must include the following:
- Patient name and address
- Patient date of birth
- Name of person to whom information is to be disclosed and relationship to patient
- Address of person to whom information is to be disclosed
- Specific health information to be disclosed
- Purpose for the release of information
A fee of $25.00 will be assessed to cover the cost of copying and for sending your records. If the records are being faxed or mailed to another medical facility, there is no charge.
Requests for forms completed by physician or staff (example: Disability forms, FMLA forms, etc.) will be charged a $25.00 fee. A $50.00 fee will be charged for immigration forms/letters. Please allow two weeks for processing. Excuses for school or work are free of charge. Please contact our Practice Manager at (512) 472-6134 if you have any questions.
Please use the Medical Records Release Form (Liberacion de Historia Medica)