Requesting Patient Records

Forms

For Patients

  1. You may request a copy of your bill be mailed, faxed or emailed to you.
  2. You may call 512-579-4000 and select option 3 OR you may submit a secure email request. (For secure email, please register on this website and then email your request to records@clinpathassoc.com.)
  3. Your request should include enough information to properly identify your account. Your name and date of birth are required.  Also specify if you need only a certain date of service or a record of a certain amount that has been paid on your account.  For example, a credit card payment in the amount of $27.50.
  4. Every effort is made to respond to these requests within 1 to 2 weeks.

For Legal Purposes

  1. Attorneys, law firms, records companies and other entities may submit requests for billing records by one of the following methods.
    1. Fax the request to (512) 222-0146 — Attn: Billing Records
    2. Mail the request to:
      • Clinical Pathology Associates
        Attn:  Billing Records
        3445 Executive Center Dr, Ste 250
        Austin, TX 78731
  2. There is a $6.50 fee for records and $15.00 fee for an affidavit. Prepayment is required before records/affidavits will be released. You may include the fee with mailed requests or an invoice will be faxed to the requestor.
  3. One of the following documents is required before we can release records.
    • HIPAA authorization signed by the patient
      1. If the patient is a minor, a parent may sign the authorization, but the parent must be clearly identified on the form.
      2. If the form is signed by a legal guardian or personal representative, you must provide proof. For example, a copy of the letters of testamentary designating a person as having power of attorney.
    • Statement of Assurance
  4. We have our own notary public for affidavits and direct questions.
  5. All records are mailed, however, a copy can be faxed upon request.
  6. If you have any questions or would like to check the status of a request, please call Eddy Campos at (512)623-3313.