Clear Lake Regional Medical Center
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Medical Records

A complete record of your care and treatment is maintained by our medical records department. These records are strictly confidential, and only authorized persons have access to them. Copy services for HCA hospitals are provided by HealthPort, and copies of your health records will be provided upon your written request and for a reasonable fee as per state law.

View and Print the Authorization Form

To request a copy of your medical records for another physician:

  • Complete an Authorization Form – ensure that all gray-colored sections are completed.
  • Specify the name of the physician, his/her address, phone, and fax number.
  • Mail or fax with a copy of a valid state issued photo ID.
  • If you are the patient’s representative (i.e., medical power of attorney), you must provide documentation indicating such, as well as a valid photo ID.
  • No fee will be charged for records forwarded directly to a physician.
  • You may complete an Authorization Form at the facility medical records department (M-F, 8am-4:30pm), and they will forward the information to Healthport for you if you are unable to print the Authorization Form from this website.

To request a copy of your medical records for personal use:

  • Complete an Authorization Form – ensure that all gray-colored sections are completed.
  • Mail or fax with a copy of a valid state issued photo ID.
  • If you are the patient’s representative (i.e., medical power of attorney), you must provide documentation indicating such, as well as a valid photo ID. (You will be contacted by Healthport, and further information may be required.)
  • There is a charge for personal copies of the medical records. The fee is .25 cents per page.
  • Healthport will contact you with an invoice for payment and the expected processing time frame for the printing and mailing of these documents.
  • After payment, your records will be mailed to you.
  • You may complete an Authorization Form at the facility medical records department (M-F, 8am-4:30pm), and they will forward the information to Healthport for you if you are unable to print the Authorization Form from this website.

Payment Information:

  • Please remit payment by check or credit card; cash cannot be accepted.
  • Make checks payable to HealthPort.

Processing:

You should expect to receive your requested copies within 7-10 days.

Privacy Practices

For any questions, please contact:

Healthport
8101 W. Sam Houston Parkway South,
Suite 100
Houston, TX 77072
Phone: 855-519-9682
Fax: 855-519-9683
Hours of Operation: 8am-5pm, M-F

View and print the Medical Authorization Form.