Requesting Access to Medical Records

HNI Healthcare will not release your medical information without written authorization. Please allow up to 15 calendar days to receive copies of your medical records after we receive your completed request forms.

To request medical records, please download the forms below and send to HNI Healthcare via email, fax, or mail. Medical records pertaining to patient care services delivered within a healthcare facility (hospitals, long-term care facilities, etc.) are not maintained separately by HNI Healthcare and should be obtained directly from the relevant healthcare facility.

Email: | Fax: (440) 542-5005 ext. 8323 | Mailing Address: 7500 Rialto Blvd Bldg 1, STE 140, Austin, TX 78735

Patient Record Request Form

Authorization for Use and Disclosure of Protected Health Information

HIPAA Privacy Related Complaint Form

Request for an Accounting of Disclosures of Protected Health Information

Restriction of Protected Health Information (PHI) Request Form

Request for Confidential Communications

Request for Amendment of or Addition to Protected Health Information

Notice of HIPAA Privacy Practices