Records Contact Information
- P.O. Box 478
- Conroe, Texas 77304
- Phone: (936) 523-1155
- Fax: (936) 539-1163
- Email: firstname.lastname@example.org
To request personal medical and/or billing records please fill out and sign the Records Authorization Form and forward it with a copy of your current Texas Drivers License (TDL) to the MCHD Records Department (addresss is on attached form) for processing.
Records Authorization Form
- MCHD requires a HIPAA compliant release signed by the patient.
- If the patient is a minor, MCHD requires a release signed by the parent or legal guardian of the minor. Authorized representative must submit copies of legal document supporting his or her authority to act on the patient’s behalf.
- In the event the patient is deceased, MCHD will require a copy of the death certificate with a HIPAA compliant release signed by the named informant or next of kin on the death certificate. This is in line with the Texas Health and Safety Code and HIPAA.
How Do I Request 911 Open Records/ Public Information Act Requests?
Open Records (Public Information Act) Requests
Chapter 552 of the Texas Government Code, also known as the Public Information Act (PIA), gives the public the right to access certain government records. The PIA also establishes procedures that governmental bodies must follow when responding to open records requests. Our goal is to handle your request accurately and as efficiently as possible.
How to Make an Open Records (PIA) Request
- Your request must be in writing (fill out the Application for Information Under Texas Public Information Act).
- Include your complete contact information, especially an e-mail address if you have one. Describe the documents, records, or data.
- We ask that your request be specific and include date ranges, if possible. We will work with you to clarify and narrow your request so that we can locate the records you are seeking. Be clear and concise.
The fees for 911 open records (dispatch record) retrieval are stated below and processed separate from the billing and medical records request. They are in line with the Texas Administrative Code Title 1, part 3, Office of the Attorney General Chapter 70 and Rule 70.3. Overhead is computed at 20 percent of the cost of labor.
Due to the uncertain amount of time it may take to research the open records, we cannot quote a total amount of the invoice. Most audio requests incur a one hour labor cost. If it is greater than that, we will fax an estimate for your approval. An invoice will be faxed when the open records are ready to mail. Please remit prepayment promptly to the address listed above and make check payable to Montgomery County Hospital District. If you have any questions, please do not hesitate to contact the MCHD Records Department at the number listed above.
911 Open Records Estimated Retrieval Fees:
- Labor Cost $15.00
- Computer Time $ 2.20
- Overhead (20% of labor costs) $ 3.00
- CD Fee (each) $ 1.00