Medical Records Release of Information (ROI) Forms

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For patients

1. Complete a medical records release of information form:

   A HIPAA-compliant Release of Information Form is required whenever you request copies of your medical records. You can also download some records from your ARC MyChart account.

   (For your convenience, we provide our patient forms online. Please bring the completed form(s) with you to your appointment. The forms below can be filled out in your browser via Adobe Reader or Acrobat, depending on browser type. Note that Adobe Reader cannot save typed data, and we suggest printing copies for your records.)

   Authorization for Use or Disclosure from ARC
   Release of Information Instructions

2. Review & pay fees:

   Austin Regional Clinic and its release of information vendors comply with all federal and state laws regarding fees for records. If payment is required, you will be contacted by ARC or the vendor with further information.

   Austin Regional Clinic is capping the fee at $25 for a two-year abstract of your medical record, including three to six months of diagnostics, regardless of page count.

3. Send the completed form to:

   ARC – Release of Information

   9503 Brown Lane
   Bldg 4, Ste 101
   Austin, Texas 78754
   Ph: 512-483-9598
   Fax: 512-406-6269

   ** At this time, we cannot accept records via any carrier other than USPS. If you need another delivery method (i.e. FedEx), please contact the phone number listed above to make arrangements. We will continue to evaluate the situation and will make updates as needed.**

4. Send payment to:

   If you have any questions, please call us at 512-483-9598 and we will handle your call promptly.

5. Receive your records by mail or pick them up in person:

   By mail:
   We will mail your records upon payment in any of the above-mentioned means.

   In person:
   At this time, we cannot allow records to be picked up in person due to COVID-19 concerns. We will continue to evaluate the situation and will make updates as needed.

For insurance companies, attorneys, APS services, or disability services

Please send your request to our Release of Information Processing Center (no prepayment is necessary):

ARC - Release of Information
9503 Brown Lane
Bldg 4, Ste 101
Austin, TX 78754
Ph: 512-483-9598
FAX: 512-406-6269

If you have any questions regarding the process for requesting records and/or associated fees, please contact our Release of Information Processing Center at 512-483-9598.

Requesting your medical records be sent to ARC

If you are a new patient establishing care at ARC and will need your medical records transferred from an outside doctor to an ARC doctor, the following form is available for your convenience:

Authorization for Release and Disclosure of PHI to Austin Regional Clinic Form

Thank you. We look forward to serving you.

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