How to Fill Out and Submit Texas Form 6700: Signatures, Fees, and Revocation

Texas Form 6700, the Use and Release of Health Information Authorization, is the state’s standard form for telling a doctor, hospital, or clinic to share your medical records with someone else — yourself, another provider, an insurer, or an attorney. Download the current PDF from the Texas Health and Human Services website, complete every required field, sign and date it, and deliver it to the medical records department of the provider that holds your chart.¹ The form exists because Texas law requires a signed authorization before a covered entity can electronically disclose your protected health information.²

Where to Get the Form

The form lives as a downloadable PDF on the Texas Health and Human Services website under the Forms section covering numbers 6000 through 6999.¹ Many hospitals and physician offices also keep printed copies at the front desk or in medical records.

Form 6700 is not the only acceptable authorization. Covered entities in Texas may use this form or any other authorization that complies with HIPAA and the Texas Medical Privacy Act, so if the facility hands you its own version, that is fine as long as it meets the legal requirements.³

How to Fill It Out

A valid HIPAA authorization needs several specific pieces of information, and Form 6700 collects all of them. Missing any one gives the provider a reason to reject the request.⁴

Patient Identification

Enter your full legal name and date of birth. Most versions also ask for the last four digits of your Social Security number as an identity check. Use the name your provider has on file. If you’ve changed your name since your last visit, note both so the records department can locate your chart.

Who Holds the Records and Who Gets Them

Clearly identify two parties: the entity disclosing the records (the doctor, hospital, or clinic currently holding your files) and the person or organization receiving them. Give the receiving party’s full name, address, and fax number or email. “My lawyer” without a name and address will slow things down.

What Information to Release

Specify exactly what you want disclosed. You can check a box for your entire medical history, or narrow the request to particular date ranges, conditions, or record types. HIPAA requires the description to be “specific and meaningful,” so “some records” won’t do.⁴ If you only need lab results from one hospital stay, say so. A narrower scope protects your privacy and speeds up the response.

Sensitive Categories

Certain records carry extra protection and require you to specifically opt in. The form has separate checkboxes for categories including mental health records, drug and alcohol treatment history, HIV/AIDS-related information, and genetic testing results. Leave those boxes unchecked and that information stays sealed even if you authorized release of everything else. A minor patient’s own signature may also be required for the release of some sensitive records.³

Purpose of the Disclosure

State why you want the records released. Common reasons: a personal copy, a legal proceeding, an insurance claim, or coordination of care with another provider. If you initiated the request yourself, “at the request of the individual” is an acceptable purpose under HIPAA.⁴

Expiration Date or Event

Every authorization must include either a specific expiration date or an event that ends it, such as “upon resolution of my insurance claim” or a calendar date six months out. An open-ended authorization with no expiration is not valid. Choose a date or event that gives the provider enough time to process the request without leaving the authorization active indefinitely.

Who Can Sign

An adult patient with decision-making capacity signs the form. If someone else signs, the provider will want proof of their legal authority, and the authorization itself must describe that authority.⁴

For a minor’s records, a parent or legal guardian signs on behalf of the child. Texas law gives providers discretion to inform parents about a minor’s treatment even without the minor’s consent, and the minor’s own signature may be required for certain sensitive categories like mental health or substance abuse records.

For an incapacitated adult, a person holding a valid Medical Power of Attorney or someone appointed by a court as the patient’s legal guardian can sign. Bring a copy of the power of attorney or the court order; the records department will likely photocopy it before processing the request.

For a deceased patient, an executor, administrator, or other person with legal authority over the estate can access records as a “personal representative” under HIPAA. The provider will ask for documentation such as letters testamentary or a court appointment.

The signature date must appear on the form and must fall before the expiration date. A form signed after its own expiration is void on arrival.

How to Submit It

Deliver the signed form to the medical records department of the provider or facility that holds your records. Do not mail it to a state agency. The form goes directly to whoever has your chart.

In person. Hand it to the medical records clerk and ask them to date-stamp your copy.
By fax. Use the facility’s medical records fax number, which is usually different from the main office line. Keep your confirmation page.
Through the patient portal, if the provider accepts uploaded documents through an encrypted online portal.
By certified mail with return receipt. This is the best option when timing matters for a legal deadline or insurance dispute, because you have proof of the date the facility received your request.

How Long the Provider Has to Respond

Texas hospitals must make records available, or tell you the records don’t exist, no later than 15 days after receiving both the completed authorization and any applicable fee.⁵ For physicians, the deadline is 15 business days after receiving written consent. Federal HIPAA rules give covered entities up to 30 days with a possible 30-day extension if they explain the delay in writing.⁶ When both apply to the same provider, the shorter Texas deadline controls.

If a provider misses the deadline, call the medical records department, reference your submission date, and ask for a specific completion date.

What Copies Cost

Providers in Texas can charge you for copying and delivering records, with fee caps set by statute and adjusted periodically. Under the schedule effective September 1, 2025, hospitals may charge up to the following:⁷

Paper copies: a retrieval fee of up to $61.79 covering the first 10 pages, then $2.09 per page for pages 11 through 60, $1.02 per page for pages 61 through 400, and $0.56 per page after that, plus actual shipping costs.
Microform records: a retrieval fee of up to $94.12 covering the first 10 pages, then $2.15 per page, plus shipping.
Electronic delivery: a retrieval fee of up to $111.94, plus any delivery costs.

A provider cannot charge you simply to look at your own records in person; the fee applies only to copies.⁵ The facility may also hold the request until the fee is paid, unless there’s a medical emergency.

Canceling an Authorization You Already Signed

You can revoke a previously signed authorization at any time by submitting a written revocation to the person or organization you named as the recipient. The revocation takes effect when the covered entity receives it, not when you mail it, so fax or hand-deliver if time matters.⁸ Any disclosures the provider already made in good-faith reliance on the original authorization remain valid; you can’t claw back records that were already sent.

A phone call isn’t enough under HIPAA. Keep the revocation letter simple: your name, date of birth, the date of the original authorization, and a clear statement that you are revoking it.

When You Don’t Need Form 6700 at All

Not every transfer of your health information requires a signed authorization. Texas law and HIPAA both allow covered entities to share protected health information without authorization for treatment, payment, and healthcare operations.² When your primary care doctor refers you to a specialist and sends your chart, that’s treatment. When a hospital bills your insurer, that’s payment. Those routine disclosures don’t need Form 6700.⁹

Other exceptions include disclosures required or permitted by law, such as responding to a court order, reporting certain communicable diseases to public health authorities, or giving limited information to law enforcement to identify a suspect or locate a missing person. Providers may also disclose information without authorization when a patient presents an immediate danger to self or others.

Psychotherapy notes, disclosures for marketing, and the sale of health information always require a separate, specific authorization. The treatment-payment-operations exception does not cover those.⁴

One last practical point: ask for a copy of your signed authorization before you leave the office. You’re entitled to one, and it’s your record of what you authorized and when.

1
Texas Health and Human Services. Form 6700, Use and Release of Health Information Authorization
2
State of Texas. Texas Health and Safety Code 181.154
3
Office of the Attorney General of Texas. Texas Health and Safety Code 181.154 – Authorization for Release of Health Information
4
eCFR. 45 CFR 164.508 – Uses and Disclosures for Which an Authorization Is Required
5
State of Texas. Texas Health and Safety Code 241.154 – Request
6
eCFR. 45 CFR 164.524 – Access of Individuals to Protected Health Information
7
Texas Health and Human Services. Maximum Fees Allowed for Providing Health Care Information
8
U.S. Department of Health and Human Services. Can an Individual Revoke His or Her Authorization?
9
eCFR. 45 CFR 164.506 – Uses and Disclosures to Carry Out Treatment, Payment, or Health Care Operations