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Cook Children's keeps a record of each lab, x-ray, medical center or specialty clinic visit.

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 health care 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 medical record from Cook Children's. Individuals over the age of 18 must authorize the release of their own information.

How to get authorization

To request a copy or have a copy of the medical record sent to another party, call Cook Children's Release of Information department in the main medical center building at 682-885-1012 between the hours of 7:30 a.m. and 5:00 p.m., Monday through Friday. 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

  • Provide all requested information.
  • Be very specific about the information you need to have released. Write down dates, types of visits and what parts of the record you need.
  • For X-ray films/images, please state on the form that you need X-ray films/images.
  • Sign and date the authorization using your full legal signature.
  • Mail authorization form to: Attention: HIM Medical Record Release, Cook Children's, 801 7th Ave., Fort Worth TX 76104 or fax to 682-885-1909. For more information, please contact a record release representative at 682-885-1012.

Please remember, we must return the form to you if any information is missing or incomplete. This may delay the release of information.

Before releasing a record

  • You must fully complete, sign and date an authorization form
  • You must provide a valid government issued picture identification card when picking up records 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 days to process a request. Please let us know if you have an urgent need and we will try to make other arrangements.

Download and print the authorization form - English
Download and print the authorization form - Spanish