Medical Records Request Form

 

 

To request a copy of your Medical Records, click on the link below to open the Authorization for the Use and Disclosure of Protected Health Information form. The form will open in Adobe Acrobat format, print the form, fill it out and fax it or bring it to the location below.
 
Medical Records Request Form (English PDF)
Medical Records Request Form (Spanish PDF)

 

 

 

 
Fax or Bring the completed, signed form to the following location:
Medical Center Hospital
Health Information Management Department
500 W. 4th Street
Odessa, Texas 79761
Phone Number: 432-640-1105
Fax Number: 432-640-2777