Request for Medical Records

Obtaining Your Medical Records

  1. To receive a copy of your medical records, an authorization to release medical information must be signed and dated by the patient or the patients legal guardian.
  2. Authorization forms can be obtained at any CommUnityCare clinic or you can download the form from this page. See the link below.
  3. The turnaround time to receive copies of health information is 15 business days.
  4. Requestors may be charged a fee to cover the expense for providing copies of health information.

You may deliver the completed request by:

  1. Fax: (512) 901-9797
  2. Drop it off at your CommUnityCare Clinic 
  3. Mail completed form to:

            CommUnityCare
            ROI
            PO Box 17366
            Austin, Texas 78760-7366

       4. 512-978-8288

Fee Schedule

  • Medical Records/Billing in paper format:  (1-20)  pages $25.00 / (>21) pages $.50 per page
  • Medical Records in Electronic format: (1-500) pages $25.00/ (>501) pages $50.00
  • Radiology images:  $8.00 per copy of an imaging study
  • Dental records:  (1-20) pages $25 (>21) pages $0.15 per page thereafter
  • Completion of Affidavit: $15.00
  • Notary fee: $6.00

Transferring Your Medical Records to CommUnityCare

  1. If you are a new patient establishing care at CommUnityCare and will need your medical records transferred from an outside provider, download the form from the link below and deliver it to your CommUnityCare clinic.
  2. Please include the name and address of your new provider on the form. Click here for a listing of our clinics. 
  3. It is important to establish a point of contact with that faculty and also provide this information to your personal clinician at CommUnityCare.

Download the form in English

Download the form in Spanish