Permian Basin Behavioral Health Center

Medical Records

The purpose of Release of Information is to provide copies of patient records to various requesters (i.e. patients, attorneys, insurance companies, etc.) for varied reasons.

When writing to obtain copies of records, please provide us with the following information:

  • The patient’s name at treatment
  • Patient’s date of birth
  • Patient’s Social Security number
  • The date(s) of treatment
  • Exact information from the date(s) of treatment
  • Where the information should be sent
  • Purpose of request
  • Sign and date the request
  • Contact phone number
  • Copy of photo ID

Please do not send requests for information or confidential information via e-mail. We cannot honor e-mail requests because a signature is required to release medical information.

The Release of Information will not provide records without a written request by the patient, the parent of a minor patient, or a legal representative. After the request is received, Release of Information should provide an answer in 15 working days. Copies of records are faxed only for emergency medical treatment (i.e. patient is in the Emergency Room or in Labor & Delivery).

There are fees to obtain copies of records. These fees must be paid prior to records being mailed to the requester. When a request is received, Release of Information will send the requester an invoice stating the fee for copies. The fees for copying records are set by the State of Texas and are reviewed for changes annually.


Authorization Form - English Authorization Form - Spanish

Mail your written request to:

Midland Memorial Hospital
ATTN: Medical Records
400 Rosalind Redfern Grover Parkway
Midland, TX 79701
Fax: (432)221-4670


Online Patient Request Tool

Patient Online Access Form – This is exclusively for patients and legal guardians with legal paperwork requesting a copy of their medical records.

Requester Submission Portal – This option is for healthcare providers, attorneys or if you are requesting the medical records of someone other than yourself and are not the legal guardian.

Release of Health Information

Midland Memorial Hospital is committed to protecting your medical information. For information about your rights and the obligations you have regarding the use and disclosure of your medical information, please see our Notice of Privacy Practices.

If you are our patient and would like to request your medical records, please click on the link below to complete your request for medical records. You will be required to provide a valid email address and a government-issued ID.

Patient Online Access Form – This is exclusively for patients and legal guardians with legal paperwork requesting a copy of their medical records

If you are our patient and would like to request your medical records, please click on the link below to complete your request for medical records. You will be required to provide a valid email address and a government-issued ID.


Click here to submit a request for medical records

If you are unable to complete the electronic form above, download and complete the paper form below. The authorization form must be legible and complete. Authorizations that are illegible or incomplete will be returned. Please note the processing of records is faster using the online form above.

Records are usually available within 10 days from the time the request is received. If you are picking up your medical records in person, please be sure to bring a government-issued ID. To arrange for another individual to pick up the documents for you, please indicate that on the authorization form, and ask them to bring their government-issued ID.

Only the patient, parent/legal guardian, or the patient’s legal health care representative can sign the form to release medical records. If you are requesting records on behalf of the patient or as the patient’s representative, please provide a copy of an Advance Directive/Durable Power of Attorney for healthcare/ Conservatorship.


Authorization Form - English Authorization Form - Spanish

Request Submission for Third Party Requesters

If you are an attorney, insurance company, or any other entity requesting records from our facility, please click on the link below to upload your request along with the patient’s authorization.


Click here to submit a request for medical records

For 3rd Party Requesters

How do I check the status of my request?
Go to https://recordstatus.sharecare.com
How do I pay for records and/or radiology images?
Go to: https://payonline.hds.sharecare.com/
How do I contact Customer Service?
You may call: 858-244-1811
Or
Contact Support for live chat: https://hds.sharecare.com/contact-us/


PocketHealth

PocketHealth is a secure online medical image sharing platform designed to make it easier for our team to exchange patient imaging records. With PocketHealth’s Patient Sharing functionality, our patients can now access, store, and share their medical imaging records anytime, at no cost, and on any device in just a few clicks.

Benefits:

  • Easily understand complex terms in your reports.
  • Imaging records are seamlessly uploaded and populated in real-time for quick access and sharing with care providers.
  • Always-on support provided by PocketHealth for patients, our referring community, and our team.
  • Bank level encryption to keep your medical information secure. 
  • All patients who receive imaging services at Midland Health will incur no expenses to access their images and reports through PocketHealth.

How does PocketHealth’s Patient Sharing work?

  • Patients will require their MRN to request access to their imaging records by signing up for PocketHealth at www.pockethealth.com/MidlandHealth and selecting the plan that’s right for them.
  • Once signed up, patients can access, store, and share their entire imaging history with any care provider or loved one.
  • Learn more about how PocketHealth works and can benefit you by checking out the training guide attached below!
  • Patients can easily understand the complex terms in their reports with PocketHealth's Report Reader.
PocketHealth Enrollment - English PocketHealth Enrollment - Spanish

Birth Certificates

The Birth Certificate office is responsible for the completion of birth certificates of babies born at Midland Memorial Hospital. To obtain copies of birth certificates, parents should visit or call:

Midland County Clerk
500 N. Loraine, 4th Floor
Midland, TX 79701
Phone: (432) 688-4401 or Fax: (432) 688-4926
Hours of Operation: Monday - Friday 8 a.m. to 4:30 p.m.

Paternity questions should be directed to the Office of the Attorney General at (800) 252-8014. Social Security questions should be directed to (800) 772-1213.

Any questions regarding the actual completion of the birth certificate for babies born at Midland Memorial Hospital should be directed to (432) 221-3295.



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