Procedure 9-1

Charges for Medical Record Duplication

Responsible Officer: Vice President for the Division of Student Affairs

Sponsoring Department: Health Services

Revision Date: 10 October 2013

Errors or changes to:

Procedure Objective

This procedure establishes medical record duplication charges for the UT Arlington Department of Health Services.


All entities requesting copies of medical and mental health records.


Medical Records Requestors
  • complete or obtain appropriate completed and signed release forms

  • provide photo identification

  • pay fees before receiving copies

Health Services Front Office Staff
  • inform requestors of all applicable requirements and fees

  • obtain fees, completed forms and photocopy of picture ID

  • input request transaction information to the Electronic Medical Record (EMR) system

  • provide duplicate records in timely manner


Section I. Completion of Medical Information Release Form
  1. Requests for release of UT Arlington medical records require completion of an Authorization for the Use and Disclosure of Protected Health Information (Form 9-7). Patient requests for release of medical records from a community provider to UT Arlington Health Services (UTAHS) require completion of an Authorization for the Use and Disclosure of Protected Health Information to Outside Entity (Form 9-8) or a community generated form containing all information found in Form 9-8.

  2. Requests received from insurance companies and attorneys must be accompanied by a release form signed by the patient and a copy of the patient’s photo identification.

  3. Front office staff will verify that the release form is accurate and complete.

  4. A copy of the patient's photo ID is attached to the request. Records will not be released without a copy of the photo ID (UTA student identification card or driver’s license with picture).

Section II. Turnaround Time for Requests

Front office staff will Inform the requestor that standard record requests have a 5 to 10 business day turnaround time and rush record requests are processed within 48 hours of receipt of the request.

Section III. "Point and Click" EMR System

Front office staff will Input the request transaction information to the EMR system.

Section IV. Charges and Payments for Records Duplication
  1. Standard fees:

    • 1 to 10 pages - $8.00
    • 11 to 60 pages - $15.00
    • more than 60 pages - $25.00
    • X-rays - $5.00 per Compact Disk (CD)
  2. Disability Requests:

    Charges are based on reasonable and customary fees paid by disability services

  3. Rush requests (within 48 hours) include the above duplication fees plus $20.00 if the information is sent by mail or $10.00 if the information is picked up by an authorized individual.

  4. Requestors must be advised of the charges and informed that fees must be paid prior to records being copied.

    1. If needed, front office staff will contact the patient regarding the necessary fees in order to obtain agreement prior to duplication of the records. The patient may be transferred to the cashier if the patient wishes to pay by credit card.

    2. The charges and other information will be input to the Point and Click system.

  5. There is no charge for the following:

    1. Copying records of University of Texas Health Services (UTAHS) patients referred by UTAHS providers for care to a community provider. Duplicate records are provided as a courtesy.

    2. Records requested by another healthcare facility for continuity of care for a UTAHS patient.

    3. Copies of pharmacy, immunization records and/or one personal copy of lab results to authorized individuals.

Forms and Tools/Online Processes

  • Authorization for the Use and Disclosure of Protected Health Information (Form 9-7)
  • Authorization for the Use and Disclosure of Protected Health Information to Outside Entity (Form 9-8)


HIPPA: The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.

FERPA: The Family Educational Rights and Privacy Act (FERPA) 34 CFR Part 99, The Family Education Rights and Privacy Act of 1974, commonly known as FERPA, is a federal law that protects the privacy of student education records. Students have specific, protected rights regarding the release of such records and FERPA requires that institutions adhere strictly to these guidelines.Any record that contains personally identifiable information that is directly related to the student is an educational record under FERPA.

House Bill 300: Concerned that HIPAA was not sufficiently strict, the Texas Legislature passed House Bill 300 in 2011. This law, expanded HIPAA provisions by requiring more stringent privacy safeguards than the federal law. HB 300 went into effect on September 1, 2012. UTAHS must comply with the most stringent regulation, in this case, HB 300 applies.


Duplicate medical records may be released to requestors who provide required identification and appropriate completed medical release forms. Charges for medical record duplicates are in agreement with Texas Administrative Code, Title 22, Part 9, Chapter 165, Rule 165.2. All applicable privacy laws and regulations are incorporated into these procedures.

Related Statutes, Policies, Requirements or Standards

UT System Administration Policies and StandardsOther Policies and Standards
Texas Administrative Code, Title 22, Part 9, Chapter 165, Rule 165.2




If you have any questions about Procedure 9-1, Charges for Medical Record Duplication, please contact the following departments:

SubjectOffice NameTelephone NumberEmail/URL
All topics in ProcedureDepartment of Health Services(817)
Website accessAdministrative Information Management(817)

Website Address for This Procedure