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Medical records authorization
[Style of Case]
AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS
TO ALL PHYSICIANS, PSYCHIATRISTS, PSYCHOLOGISTS, DENTISTS, CHIROPRACTORS, PHYSICAL THERAPISTS, COUNSELORS, HOSPITALS, CLINICS, LABORATORIES, AND OTHER HEALTH CARE PROVIDERS:
I, [name of person authorizing release], authorize [name of person/firm authorized to obtain records] or any of [his/her/its] representatives to obtain all information pertaining to my physical, medical, mental, psychiatric, and/or psychological condition and treatment by you. Such information includes, but is not limited to, x-rays, laboratory reports, all tests of any type, treatment for drug and/or alcohol abuse or addiction, correspondence, neuropsychological testing and evaluations, reports or documents from any other caregiver(s) during my treatment, diagnostic studies, nurses’ notes, progress notes, charts, clinical abstracts, prescriptions, and all other records pertaining to my condition, care, treatment, and prognosis thereof, including narrative reports of, or interviews regarding, your examination, findings, and opinions.
In accordance with Tex. Health & Safety Code § 241.154(a), please provide a copy of the medical information specified above to [name of person/firm authorized to obtain records] within fifteen (15) days of the date you receive this authorization or a photocopy thereof and payment of reasonable copying fees.
This authorization is to be used in connection with the above-captioned lawsuit filed by me. This authorization is subject to revocation at any time except to the extent that the person or entity which is to make the disclosure has already taken action in reliance on it. Under Texas law, a revocation is valid only if it is in writing, dated after the date of this authorization, and signed by me or my legally authorized representative. If not...
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- Discovery Forms
- Medical records authorization
- Authorization for Texas Worker’s Compensation Commission Records
- Employment Records Authorization
- Scholastic Records Authorization
- Military Records Authorization
- Oral and Video Deposition Duces Tecum Propounded to Defendant for Employment Cases in General
- Oral and Video Deposition Duces Tecum to Plaintiff for Employment Cases in General
- Deposition Duces Tecum Propounded to Defendant City, Whistleblower Case
- Deposition Outline Checklist: Plaintiff’s Deposition of Defendant’s Employees: General Questions
- Deposition Checklist: Deposing the Plaintiff in Employment Cases (In General)
- Deposition Outline (Plaintiff) - False Imprisonment
- Standard Responses, Objections, and Answers to Interrogatories For Defendants and Plaintiffs
- Standard Responses, Objections, and Answers to Request for Production of Documents for Both Defendants and Plaintiffs
- Standard Instructions and Definitions for Defendant’s Written Discovery to Plaintiff
- Defendant's "Triple Threat" Discovery Propounded to Plaintiff in Employment Cases in General
- Defendant's "Triple Threat" Discovery Propounded to Plaintiff Employee's Spouse
- Sworn Statement by Non-Managerial Employee of Defendant
- Standard Instructions and Definitions for Plaintiff's Written Discovery to Defendant
- Plaintiff's "Triple Threat" Discovery to Defendant in Age Discrimination Case
- Plaintiff's Standard "Triple Threat" Discovery to Defendant in Employment Cases in General
- Plaintiff's "Triple Threat" Discovery Propounded to Defendant in Sexual Harassment Case
- Plaintiff's First Request for Production of Documents Propounded to Defendant City in a Whistleblower Case
- FOIA Request to the EEOC
- Open Records Request to the TCHR
- Standard Responses, Objections, and Answers to Interrogatories for Defendants and Plaintiffs Under Texas Rules of Civil Procedure
- Standard Responses, Objections and Answers to Request for Production of Documents for Defendants and Plaintiffs Under Texas Rules of Civil Procedure
- Request for Disclosures (Short Form) (State)
- Request for Disclosures (Long Form) (State)
- Discovery Plan (Worksheet)
- Deposition Outline - Economist
- Deposition Outline - Medical/Mental Health Professional
- Plaintiff's Proposed Pattern Interrogatories and Request for Production
- Level Three Discovery Control Plan
- Authorization for Release of Financial Records
- Motion to Compel Discovery (State)
- Deposition Outline - Corporate Representative - Products Liability
- "About Your Upcoming Deposition"
- Defendant's "Triple Threat" Discovery to Plaintiff - Race, Age & Firing
- Defendant's "Triple Threat" Discovery to Plaintiff - Sexual Harassment and Firing
- Plaintiff's "Triple Threat" Discovery to Defendant - Sex Discrimination (State Court)
- Plaintiff's "Triple Threat" Discovery to Former Employee Stealing Trade Secrets
- Petition Requesting Deposition Before Suit
- Opposition to Pre-Suit Deposition
- Order Authorizing Deposition
- Defendant's First Set of Interrogatories to Plaintiff-FLSA
- Defendant's First Set of Requests for Production to Plaintiff-FLSA
- Plaintiff's Triple-Threat to Defendant re: Stealing Trade Secrets
- Request For Disclosure To Defendant-FMLA, ADEA
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