Medical Records Requests

The Urban Inter-Tribal Center of Texas provides release of information services for patients who request medical records. Patient medical records are available in adherence with all state and federal regulations for the release of information. There are no fees to obtain copies of medical records.

Access Your Medical Records Online

Some of your health information is easily accessible by signing up for PHR (Personal Health Record) – a secure, online portal to your health record. Past appointments, after appointment instructions and most test results are available in PHR. Through PHR you are also able to send secure messages to our clinic staff about anything you would normally call about – appointments, medication requests, or questions. Sign-up online for a PHR – Personal Health Record account at You can also sign-up during your next clinic visit by asking the Clinic Front Desk staff.

Fill out a Medical Records Request Form

To receive copies of medical records, download the IHS Medical Records Release Form.

Download Medical Records Release Form 

To obtain copies of records, please fill in all fields on the form, including:

– Patient’s name at treatment
– Patient’s date of birth
– The date(s) of treatment
– Address where the information should be sent
– Purpose of request
– Sign and date the request

The Medical Records Department will not provide records without a written request by the patient, the parent of a minor patient or a legal representative.

Submit a Medical Records Request Form

Completed Medical Records Request forms can be submitted to us by mail, fax, or in person at the Primary Care Clinic Front Desk.

Urban Inter-Tribal Center of Texas
ATTN: Release of Information
1283 Record Crossing Road
Dallas, TX 75235
(214) 946-4738

Please do NOT send requests through email. We cannot honor email requests because a signature is required to release medical information.

Processing time for Medical Records Requests

After the request is received, the Release of Information office will process the request within 15 business days. Processing time is the amount of time the UITCT may take to process the request, it does not include mailing time. Copies of records will be sent by mail, we can only fax medical records less than 15 pages total if needed for emergency medical treatment.

Urgent Requests for Medical Records

If you feel your request is urgent or there is a medical necessity to receive the records sooner than the given timeframe, please contact Koty Van Zile in our Release of Information department at (214)941-1050 ext. 233.