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HIPAA Release Form Texas

HIPAA Release Form Texas

Texas Medical Records Release Form

Click here for HIPAA release form

(free PDF document – Opens directly in browser)

This Texas HIPAA release form provides patients with access to their personal health records. The HIPAA form also allow healthcare providers to share records, with the form specifying when the information can be shared and what it can be used for. The HIPAA release form can be revoked at any time.

Texas Fees for Releasing Medical Records

State Maximum Fees ($)
Alabama Medical Record Search Fee: $5

Copied Pages Supplied 1-25: $1/page

Copied Pages Supplied 26+: $0.50

Other Documents: Actual cost of reproduction.

Arizona Reasonable Fee
Arkansas Medical Record Search Fee: $15

Copied Pages Supplied 1-25: $0.50/page

Copied Pages Supplied 26+: $0.25/page

California Medical Record Search Fee: $4

Evidence Fee: $15

Copied Pages Supplied 1+: $0.10/page

Microfilm: $0.20/page

Colorado Medical Record Search Fee: $18.53 flat fee (First ten Copied Pages Supplied)

Copied Pages Supplied 11 – 40: $0.85 per page

Copied Pages Supplied 41+: $0.57 per page

Microfilm: $1.50 per page

Connecticut Copied Pages Supplied 1+: $0.65 per page
Delaware Copied Pages Supplied 1 – 10: $2.00 per page

Copied Pages Supplied 11 – 20: $1.00 per page

Copied Pages Supplied 21 – 60: $0.90 per page

Copied Pages Supplied 61+: $0.50 per page

Microfilm: Actual cost of reproduction.

Florida Medical Record Search Fee: $1.00 (Per year per request)

Copied Pages Supplied 1+: $1.00 per page

Microfilm: $2.00 per page

Georgia Medical Record Search Fee: $25.88

Copied Pages Supplied 1 – 20: $0.97 per page

Copied Pages Supplied 21 – 100: $ 0.83 per page

Copied Pages Supplied 101+: $0.66 per page

Certification Fee: $9.70

Hawaii Reasonable Fee
Illinois Medical Record Search Fee: $29.09

Copied Pages Supplied 1 – 25: $1.09 per page

Copied Pages Supplied 26 – 50: $0.73 per page

Copied Pages Supplied 50+: $0.36 per page

Microfilm: $1.82 per page

Indiana Medical Record Search Fee: $20.00 (includes first 10 Copied Pages Supplied)

Copied Pages Supplied 11 – 50: $0.50 per page

Copied Pages Supplied 51+: $0.25 per page

Affidavit/Certification: $20.00

Iowa Reasonable Fee
Kansas Reasonable Fee
Kentucky First (1st) Copy: Free

Second (2nd) Copy: $1.00 per page

Louisiana Medical Record Search Fee: $25.00

Copied Pages Supplied 1 – 25: $1.00 per page

Copied Pages Supplied 26 – 350: $0.50 per page

Copied Pages Supplied 351+: $0.25 per page

Max Fee for Electronic Records: $100.00 per request

Maine Medical Record Search Fee: $5.00 (Includes first page)

Copied Pages Supplied 2+: $0.45 per page

Max Fee: $250.00

Max Fee for Electronic Records: $150.00 per request

Maryland Medical Record Search Fee: $22.88

Copied Pages Supplied 1+: $0.83 per page

Electronic Records Medical Record Search Fee: $22.88

Electronic Records Copied Pages Supplied 1+: $0.62 per page

Max Fee for Electronic Records: $81.63 per request

Massachusetts Medical Record Search Fee: $25.01

Copied Pages Supplied 1 – 100: $0.84 per page

Copied Pages Supplied 100+: $0.43 per page

Social Security: No charge for a request to support a claim under the social security act.

Michigan Medical Record Search Fee: $25.38

Copied Pages Supplied 1 – 20: $1.27 per page

Copied Pages Supplied 21 – 50: $0.63 per page

Copied Pages Supplied 51+: $0.25 per page

Minnesota Medical Record Search Fee: $19.19

Copied Pages Supplied 1+: $1.44 per page

X-rays: $10 Medical Record Search Fee plus the actual cost of reproduction.

Mississippi Medical Record Search Fee: $20.00 Flat Fee (first 20 Copied Pages Supplied)

Copied Pages Supplied 21 – 100: $1.00 per page

Copied Pages Supplied 101+: $0.50 per page

Search/Storage Fee: $15.00 (Only charged if records are retrieved from off-site location)

Certification Fee: $25.00

Missouri Medical Record Search Fee: $26.06

Copied Pages Supplied 1+: $0.60 per page

Storage Fee: $24.40 (Additional fee if records are retrieved off-site)

Max Fee for Electronic Records: $114.17

Montana Medical Record Search Fee: $15.00

Copied Pages Supplied 1+: $0.50 per page

Nebraska Medical Record Search Fee: $20.00

Copied Pages Supplied: 1+: $0.50 per page

X-rays: Actual cost of reproduction.

Nevada Copied Pages Supplied 1+: $0.60 per page

X-rays: Reasonable Fee

New Hampshire Whichever is greater: $15 for first 30 Copied Pages Supplied or $0.50 per page
X-rays: Reasonable Fee
New Jersey Medical Record Search Fee: $10.00

Copied Pages Supplied 1 – 100: $1.00 per page

Copied Pages Supplied 101+: $0.25 per page

Max Fee: $200.00

New Mexico Copied Pages Supplied 1 – 15: $30.00 flat fee

Copied Pages Supplied 16+: $0.25 per page

X-rays: Actual cost of reproduction.

New York Copied Pages Supplied 1+: $0.75 per page

X-rays: Actual cost of reproduction.

North Carolina Copied Pages Supplied 1 – 25: $0.75 per page

Copied Pages Supplied 26 – 100: $0.50 per page

Copied Pages Supplied 100+: $0.25 per page

Minimum Fee: $10.00

North Dakota Medical Record Search Fee: $20.00 (Includes Copied Pages Supplied 1-25)

Copied Pages Supplied 26+: $0.75 per page

Electronic Records Medical Record Search Fee: $30.00 (Includes Copied Pages Supplied 1-25)

Electronic Records Copied Pages Supplied 26+: $0.25 per page

Ohio Medical Record Search Fee: $20.42

Copied Pages Supplied 1 – 10: $1.34 per page

Copied Pages Supplied 11 – 50: $0.69 per page

Copied Pages Supplied 51+: $0.27 per page

X-rays: Medical Record Search Fee plus $2.27 per page

Oklahoma Medical Record Search Fee: $10.00

Copied Pages Supplied 1+: $0.30 per page

X-rays: $5.00 per page

Max Fee: $200.00

Oregon Medical Record Search Fee: $30.00 (Includes Copied Pages Supplied 1-10)

Copied Pages Supplied 11-50: $0.50 per page

Copied Pages Supplied 51+: $0.25 per page

X-rays: Actual cost of reproduction.

Pennsylvania Medical Record Search Fee: $23.45

Copied Pages Supplied 1 – 20: $1.58 per page

Copied Pages Supplied 21 – 60: $1.17 per page

Copied Pages Supplied 61+: $0.40 per page

Microfilm: $23.45 + $2.33 per page

Rhode Island Copied Pages Supplied 1 – 10: $2.50 per page

Copied Pages Supplied 10 – 50: $0.75 per page

Copied Pages Supplied 51+: $0.50 per page

South Carolina Medical Record Search Fee: $26.67

Copied Pages Supplied 1 – 30: $0.69 per page

Copied Pages Supplied 31+: $0.53 per page

Max Fee for Electronic Records: $160.05

South Dakota No Current Fee Schedule
Tennessee Medical Record Search Fee: $18.00 (Includes Copied Pages Supplied 1 – 5)

Copied Pages Supplied 6 – 50: $0.85 per page

Copied Pages Supplied 51 – 250: $0.60 per page

Copied Pages Supplied 251+: $0.35 per page

Texas Medical Record Search Fee: $48.77 (Includes Copied Pages Supplied 1 – 10)

Copied Pages Supplied 11 – 60: $1.64 per page

Copied Pages Supplied 61 – 400: $0.80 per page

Copied Pages Supplied 401+: $0.44 per page

Utah Medical Record Search Fee: $21.16

Copied Pages Supplied 1 – 40: $0.53 per page

Copied Pages Supplied 41+: $0.32 per page

Vermont Whichever is greater: $5 or $0.50 per page

Social Security: No charge for a request to support a claim under the social security act.

Virginia Medical Record Search Fee: $20.00

Copied Pages Supplied 1 – 50: $0.50 per page

Copied Pages Supplied 51+: $0.25 per page

Max Fee: $150.00

Electronic Records Medical Record Search Fee: $20.00

Electronic Records Copied Pages Supplied 1 – 50: $0.37 per page

Electronic Records Copied Pages Supplied 51+: $0.18 per page

Electronic Records Max Fee: $150.00

Microfilm Medical Record Search Fee: $20.00

Microfilm Copied Pages Supplied 1+: $1.00 per page

Washington Medical Record Search Fee: $26.00

Copied Pages Supplied 1 – 30: $1.17 per page

Copied Pages Supplied 31+: $0.88 per page

West Virginia Medical Record Search Fee : $20.00

Copied Pages Supplied 1+ : $0.40 per page

Copied Pages Supplied 1+ Electronic Records: $0.20 per page

Max Fee Electronic Records: $150

Wisconsin Medical Record Search Fee: $22.61

Copied Pages Supplied 1 – 25: $1.14 per page

Copied Pages Supplied 26 – 50: $0.86 per page

Copied Pages Supplied 51 – 100: $0.56 per page

Copied Pages Supplied 101+ $0.34 per page

Microfilm and other media: $22.19 + $1.68 per page

X-rays : $22.19 + $11.28 per series

Certification (if not patient or their representative): $9.04 per request