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Medical or Treatment Records Requests

Medical or Treatment Records Requests

Requests for copies of any medical, treatment, or financial records or records of other services provided by Metrocare must be sent to Metrocare Services Release of Information (“ROI”) Department. The ROI Department receives and processes requests for copies of records relating to:

  • Your medical care or treatment services;
  • Information about your past, present, or future physical or mental health or condition;
  • Healthcare or any other services provided to you by Metrocare; and
  • Financial information relating to past, present, or future payment for your healthcare or other services received by Metrocare.

Requesting Your Records

If you are requesting a copy of your own records:

  1. Complete the Authorization of Release of Information Form – English, Spanish (For best results, please open the form in Chrome or Adobe Acrobat. Please note that all sections on the form must be filled out and the form must be signed for your request to be processed.)
  2. Make a copy of your driver’s license/photo identification
  3. Mail, Fax, or E-mail (Choose only one to avoid duplication) your completed form and a copy of your driver’s license/photo identification to:
    • If by Mail: Attn: Release of Information, Metrocare Services, 1345 River Bend Drive, Suite 200, Dallas, Texas 75247
    • If by Fax: (214) 983-1980
    • If by E-mail: ROI@metrocareservices.org 

Requesting records of your child, another family member, or another person

If you are requesting a copy of records of your child/children:
 
  1. Complete the Authorization of Release of Information Form – English, Spanish for each child. (For best results, please open the form in Chrome or Adobe Acrobat. Please note that all sections on the form must be filled out and the form must be signed for your request to be processed.)
  2. Make a copy of your driver’s license/photo identification
    • If you are the legal guardian (not a parent), make a copy of your guardianship order
  3. Mail, Fax, or E-mail (Choose only one to avoid duplication) your completed form, a copy of your driver’s license/photo identification, and, if applicable, a copy of your guardianship order to:
    • If by Mail: Attn: Release of Information, Metrocare Services, 1345 River Bend Drive, Suite 200, Dallas, Texas 75247
    • If by Fax: (214) 983-1980
    • If by E-mail: ROI@metrocareservices.org 

If you are requesting a copy of records for a family member or another person:

  1. Complete the Authorization of Release of Information Form – English, Spanish (For best results, please open the form in Chrome or Adobe Acrobat. Please note that all sections on the form must be filled out and the form must be signed for your request to be processed.)
  2. Make a copy of your driver’s license/photo identification
  3. Make a copy of written documentation that supports:
    • Authorization and consent from the person, with printed name and signature, whose records you are requesting; and/or
    • You are the authorized person to request and receive the requested records on behalf of the person whose records are requested
      1. Examples: Power of Attorney, Guardianship Order, court order, proof or documents indicating legally authorized representative designation, attorney information, affidavits, etc. 
      2. If the person is deceased, please provide a copy of the death certificate and supporting documentation indicating your authorization to request and receive the records of the deceased person
  4. Mail, Fax, or E-mail (Choose only one to avoid duplication) your completed form, a copy of your driver’s license/photo identification, and supporting documentation to:
    • If by Mail: Attn: Release of Information, Metrocare Services, 1345 River Bend Drive, Suite 200, Dallas, Texas 75247
    • If by Fax: (214) 980-1980
    • If by E-mail: ROI@metrocareservices.org 

Charges and fees

You may be charged a fee for any costs associated with completing your request. You will be notified in advance of any costs involved in your request by a representative of the ROI Department.

Process time

After submitting your request, a member of the ROI Department will contact you regarding your request. Metrocare has fifteen (15) business days to complete your request after receiving your request. If for any reason we are unable to complete your request within the 15 business days, you will be notified by a representative of the ROI Department and will be provided with an estimate of when your request can be completed.  

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1.9M

Texans live with a serious and persistent mental illness

6.4M

Texans have a mental illness and would benefit from treatment

17K

children received care from Metrocare last year

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