Medical Records

Request a copy of your medical records

1. Download, print and complete the authorization form
2. Complete all highlighted areas. Be sure to specify the dates of service and type of information needed (i.e., ER report from 6/10/06 visit)
3. Place the completed authorization form in an envelope and mail to Medical Records address listed on the form
   
4. Original signature is required therefore faxed requests will be returned unprocessed

Fees
If you are requesting records sent to you or to a physician outside of Beaumont, you will receive a bill.

There is no charge if your record is sent directly to a physician or another health care facility.

Questions
If you have questions, please contact our Medical Record correspondence clerk at:

1. Download, print and complete the authorization form
2. Complete all highlighted areas. Be sure to specify the dates of service and type of information needed (i.e., ER report from 6/10/06 visit)
3. Place the completed authorization form in an envelope and mail to Medical Records address listed on the form
   
4. Original signature is required therefore faxed requests will be returned unprocessed

If you are requesting records sent to you or to a physician outside of Beaumont, you will receive a bill.

Fees
There is a charge of twenty-five cents ($0.25) per page to receive a copy of your medical record for your own personal use.

There is no charge if your record is sent directly to a physician or another health care facility.

Questions
If you have questions, please contact our Medical Record correspondence clerk at:

1. Download, print and complete the authorization form
2. Complete all highlighted areas. Be sure to specify the dates of service and type of information needed (i.e., ER report from 6/10/06 visit)
3. Place the completed authorization form in an envelope and mail to Medical Records address listed on the form
   
4. Original signature is required therefore faxed requests will be returned unprocessed

Fees
If you are requesting records sent to you or to a physician outside of Beaumont, you will receive a bill.

There is no charge if your record is sent directly to a physician or another health care facility.

Questions
If you have questions, please contact our Medical Record correspondence clerk at:

You can come to the Medical Records Department to sign an authorization form or pick up copies of records. Patients who are picking up their medical records can park in the visitor parking deck just outside the main entrance.

1. Download, print and complete the authorization form
2. Complete all highlighted areas. Be sure to specify the dates of service and type of information needed (i.e., ER report from 6/10/06 visit)
3. Place the completed authorization form in an envelope and mail to Medical Records address listed on the form
   
4. Original signature is required therefore faxed requests will be returned unprocessed

Fees
If you are requesting records sent to you or to a physician outside of Beaumont, you will receive a bill.

There is no charge if your record is sent directly to a physician or another health care facility.

Questions
If you have questions, please contact our Medical Record correspondence clerk at:

You can come to the MISD records pick-up window located at the South Tower Entrance to sign an authorization form or pick up copies of records. See the entrance attendant at the South Tower Entrance for parking directions.

1. Download, print and complete the authorization form
2. Complete all highlighted areas. Be sure to specify the dates of service and type of information needed (i.e., ER report from 6/10/06 visit)
3. Place the completed authorization form in an envelope and mail to Medical Records address listed on the form
   
4. Original signature is required therefore faxed requests will be returned unprocessed

Fees
If you are requesting records sent to you or to a physician outside of Beaumont, you will receive a bill.

There is no charge if your record is sent directly to a physician or another health care facility.

Questions
If you have questions, please contact our Medical Record correspondence clerk at:

You can come to Area C, Suite 118 to sign an authorization form or pick up copies of records. They should see the Valet attendant and will be directed to a short term parking area.

1. Download, print and complete the authorization form
2. Complete all highlighted areas. Be sure to specify the dates of service and type of information needed (i.e., ER report from 6/10/06 visit)
3. Place the completed authorization form in an envelope and mail to Medical Records address listed on the form
   
4. Original signature is required therefore faxed requests will be returned unprocessed

Fees
If you are requesting records sent to you or to a physician outside of Beaumont, you will receive a bill.

There is no charge if your record is sent directly to a physician or another health care facility.

Questions
If you have questions, please contact our Medical Record correspondence clerk at: