To request copies of your own medical records, or to authorize the disclosure of your medical records to another individual or third party, you will need to complete a HIPAA compliant form and submit your request in writing to the Health Information Services (HIS) department. Note: Please be sure to complete all sections when filling out the form.

Patients, legal guardians and personal representatives with legal authority to make health care decisions on behalf of the individual may obtain medical record copies by one of two methods:

1. Completing a Patient Request for Information form: (English) (Español), or
2. Submitting a request to release the medical record through the Shriners Hospitals for Children Patient Portal. (Note: This process does not require completion of the form listed above.)
   • If you already have access to the Shriners Hospitals for Children Patient Portal, see instructions here.
   • If you do not yet have access to the Shriners Hospitals for Children Patient Portal, contact the Shriners Hospitals for Children registration staff or care manager at this location to request an invitation.

Third parties may obtain medical record copies by submitting an Authorization for Disclosure of Health Information form that is completed and signed by the patient and/or legal guardian: (English) (Español).

For personal assistance with your medical record request, please contact the medical records office at 713-793-3939. You can download and fax the forms to 713-793-3770 or mail to:

Shriners Hospitals for Children — Houston
Medical Records
6977 Main St.
Houston, Texas 77030

We can also send this form to you via fax or email.

If you prefer, you may pick up an authorization form in person by stopping by the medical records office during our regular business hours: 8 a.m.–4:30 p.m., Monday – Friday.

Insurance questions

At Shriners Hospitals for Children — Houston, there are no barriers to care. Doctors determine the course of care and all care is provided regardless of the families' ability to pay. For families with insurance, the hospital will accept payment from insurance providers. However, insurance coverage is not required for care. Any child under 18 with a medical condition that is within the scope of services provided is eligible for care.

For insurance-related questions, please call our financial counseling hotline at 713-793-3986.