Patient Medical Records
Central Health Specialty Care Patient information
Notice of Privacy Practices
Purpose of this form: it is required by the HIPAA Privacy Rule and explains to patients, employees, and clients how their information will be collected, processed, stored, and used and outlines their privacy rights.
Patients’ Rights and Responsibilities
Purpose of this form: educate the patients on what their rights and responsibilities are.
Central Health Specialty Care Release of Information Forms
Authorization for Disclosure, Use, or Release of Protected Behavioral Health Information
Purpose of this form: if a patient/legal representative is wanting to obtain a copy of their Behavioral Health Records/Psychotherapy Notes from Central Health or would like for the information to be released to a third party they would have to complete this form.
Authorization for Disclosure, Use, or Release of Protected Health Information
Purpose of this form: if a patient/legal representative is wanting to obtain a copy of their Medical Records/Diagnostic Imaging from Central Health or would like for the information to be released to a third party they would have to complete this form.
How to Request Central Health Patient Records
Patients can obtain/request a copy of their medical records using MyChart.
Patients can complete a ROI form and return it, and external entities can send requests to:
- Fax: 512.776.0492
- Email: CHHIM@heqing116.com
- Mail: PO Box 300086, Austin TX 78703
Related information
Subrogation requests: Here
Public information requests: Here
CommUnityCare forms and patient records: Here
Please submit your question related to release of information forms or how to obtain patient records.