Medical Records and Information Requests
If you have received services by Connections Wellness Group and would like a copy of your medical records or information, please view the information below for instructions.
How to Request Personal Medical Records
To request medical records, a “Request for Medical Records” form will need to be filled out that will be placed in your patient portal. To submit your form, you have two options:
Fax the request to 940-228-1298
Email medical records at [email protected]
For all medical records requests to be sent to you directly, there is a $25 processing fee. Once the processing fee is taken and the request form is completed, it can take up to 15 business days to process the request.
There is a cost associated for personal requests, but not for provider requests. Please see our FAQs for more information.
Litigation Requests
The cost is $300 fee per one hour, billed in a minimum of quarter-hour increments ($75 for every 15 minutes) for the time it takes to gather this information. If an affidavit is requested, a fee of up to $15 may be charged for executing the affidavit.
The reason this fee is more than the $25 request for records fee is because of the process it takes to get the notes approved by the providers.
FMLA and Disability Requests
There is a policy for FMLA, short-term disability insurance (STD) and long-term disability insurance (LTD) that lists all necessary information.
If a patient is interested in FMLA/STD/LTD they must contact their employer’s HR department and they will then fax us the appropriate documents. A consent form must be completed for the requested organization or employer. The paperwork is faxed directly to the requesting employer/organization. If a patient wants copies of the paperwork or records, they will need to go through the request for medical records process.
It is up to the provider whether they agree to complete the paperwork. It is up to the provider whether they provide an extension on the FMLA paperwork and duration of the extension. FMLA paperwork will not be completed until a patient has been seen for a minimum of 3-6 months or up to the provider’s discretion.
There is a $75 processing fee for FMLA and a $100 processing fee for STD/LTD. There is no fee if the patient is currently in PHP/IOP.
It can take up to 15 business days to process your request but we do our best to process them as quickly as possible.
Requests for Accommodations/Miscellaneous Letters
CWG providers will no longer write or sign emotional support letters (ESA).
No paperwork requesting clearance for plasma donation will be filled out; the patient will need to defer to their PCP.
All letters and accommodation forms cost $35. This is more than the $25 request fee because of the process and time it takes to connect with the provider to fill out the paperwork.
It is up to the provider whether they agree to complete the paperwork. It is up to the provider whether they provide an extension on the FMLA paperwork and duration of the extension. FMLA paperwork will not be completed until a patient has been seen a minimum of 3-6 months or up to the provider’s discretion.
Medical Records FAQs
How do I complete the consent or request form?
The forms are completed in your patient portal. If you do not see the form, reach out to the location you are seen at and they will add it to your patient portal. The form can also be completed at any CWG location.
The requesting provider/business sent a completed consent form with their request, why do I have to complete one with you, too?
To abide by HIPAA guidelines and protect patient information, we must get approval from the patient directly that they are aware of the request and consent to it. No records will be processed without a completed CWG consent form.
How long does it take to receive medical records after a personal request?
It can take up to 15 business days to process requests, but we do our best to process them as quickly as possible.
How are medical records delivered?
For personal requests, medical records can be printed and picked up (see notes for additional fees) or sent via encrypted email.
How much does it cost to request personal medical records?
In accordance with the Health and Safety Code, Subsection 241.154€, the fee effective as of January 20, 2017, for providing a patient’s health care information are as follows:
For paper copies: $25 retrieval or processing fee, which includes providing the first 20 pages of records. PLUS: $0.50 per page for pages 26+
For electronic copies: $25 Retrieval or processing fee, which includes providing the first 500 pages. PLUS: $25 for pages 501+
NOTE: If you want your records to be sent to another provider, we recommend having the provider send a request as those types of requests are free of charge. Is there a fee when the medical records request is made by an organization?
There is no charge when the request is coming from an organization. A consent form will be placed in patient’s portal to fill out and sign for us to release the requested records unless the organization includes one.
Get Support from Connections Wellness Group
Do you need more support? Our trained professionals are here to help you with your mental health concerns and medications. Contact our team online or by phone at (877) 747-4294 to arrange an appointment.