Copy Fee Information

MEDICAL RECORD REQUEST FEES (Pre-Payment Required)

Effective 9/14/2015, patients of The Carrell Clinic™ who request a copy of their medical records will be assessed a fee pursuant to Texas State Statute Chapter 134 Section 134.120, as shown below:

  • Standard Medical Records
    • $25.00 per request (Per Government Regulation HHS 45 CFR 164.524)
    • $8.00 per CD
  • X-rays and Diagnostic Imaging Studies
    • $8.00 per CD
  • Workers Comp
    • $15.00 for pages 1-20
    • $0.30 for each additional page over the first 20 pages
  • Workers Comp Narrative Report – Preparation
    • $50.00 for pages 1-2
    • $20.00 for each additional page over the first 2 pages
  • Workers Comp Narrative Report – Copies
    • $0.50 per page
  • Affidavit Execution
    • $15.00 per affidavit
  • Notary Execution
    • $6.00 per notarized document
  • Disability Forms Preparation
    • $20.00 for all new disability forms
    • $10.00 for any disability forms which need to be updated
    • *Prepayment is required before disability forms are processed*

 

SECURE WEB DELIVERY OF YOUR RECORDS IS NOW AVAILABLE:

We provide the ability for you to access your requested information via the web. Please let us know if you would like to use secure internet delivery.