Request medical records
To request a copy or have a copy of the medical record sent to another party, call Cook Children's Northeast Hospital's Health Information Management Department at 817-605-2984 between the hours of 8:00a.m. and 5:00 p.m., Monday through Friday. We will be happy to mail, fax or email you a form.
The privacy of this information is protected by federal and state regulations. This means your medical information is only available to the Cook Children's healthcare professionals caring for you or your child. Everyone else must get special permission (called authorization) before the information can be released.
Who must authorize release of information
Parents or legal guardians (without court imposed restrictions) may obtain and/or authorize the release of protected health information from their child's Cook Children's Northeast Hospital's medical record. Individuals 18 or older must authorize the release of their own information.
We will be happy to mail or fax you a form. You may also get a form from your Specialty Clinic or download it here in English or Spanish.
Written authorization, what to do
- Carefully read the authorization form.
- Provide all requested information.
- Be very specific about the information you need released. Write down date, types of visits, and what parts of the record you need. (if you do not know specific dates of service a date range can be used: For example month & year or just year)
- For imaging reports (i.e. x-rays, ultrasounds, MRI, etc.) please check the box on the form that you need imaging reports.
- Sign and date the authorization using your full legal signature.
- Please remember, we will return the form to you if any information is missing or incomplete. This may delay the release of information.
- Mail completed authorization form to;
- Attention: HIM Medical Record Release
Cook Children's Northeast Hospital
6316 Precinct Line Rd
Hurst, Texas, 76054
Fax to 817-605-2985.
Before releasing a record
- Picking up copy of record(s) - You must provide a valid current government issued picture identification card when picking up records from our office.
- Request copy of record(s) be mailed - You must provide a legible copy of a valid current government issued picture identification card (i.e. Driver License, passport, etc.) along with the completed Authorization form when records are requested to be mailed from our office.
Fee for release
There is a fee for release of copied medical records. This fee must be paid at the time of, or before the release is completed.
Time for release
Because of the number of requests we receive, it may take up to 15 business days to process a request. If you plan on picking up the records, please call ahead of time to ensure they are ready when you arrive.
If you have any questions related to any of the above, please contact HIM at 817-605-2984.