Request for PHICorrectional Managed Care

Requests for protected health information (PHI) are processed according to:

• Presently incarcerated inmate (request from family member)
• Presently incarcerated inmate (request other than family member)
• Discharged inmate
• Deceased inmate
• UTMB TDCJ Hospital Galveston PHI

Presently incarcerated inmate: Requests for PHI from family members must be mailed in writing to the inmate’s unit of assignment. Please include the inmate name and TDCJ number. The unit medical staff will obtain a signed Authorization to Release PHI from the inmate.  If fees apply, a fee letter will be mailed to the address provided by the requestor.  Upon receipt of a money order payable to UTMB-CMC from the family member, copies of the requested records will be mailed to the requestor.

Presently incarcerated inmate: Requests for PHI from a third party other than a family member may be mailed, faxed or emailed to Health Services Archives. Please include the inmate name and TDCJ number.  The unit medical staff will obtain a signed Authorization to Release PHI from the inmate.  If fees apply, a fee letter will be mailed to the address provided by the requestor.  Upon receipt of a money order payable to UTMB-CMC from the family member, copies of the requested records will be mailed to the requestor.

Health Services Archives
262 FM 3478 Ste. B
Huntsville, Texas 77320

Email:  cmchealthservicesarchives@utmb.edu  Fax:  936-439-1350

Discharged inmate:  Requests for a discharged inmate’s PHI must be sent to Health Services Archives via mail, fax or email.  Please include the inmate name and TDCJ number.  If necessary, Health Services Archives staff will mail a blank authorization to release PHI to the requestor.  The authorization to release PHI will have to be signed by the discharged inmate.  If fees apply, a fee letter will be mailed to the address provided by the requestor.  Upon receipt of a money order payable to UTMB-CMC from the requestor, copies of the requested records will be mailed to the requestor.

Health Services Archives
262 FM 3478 Ste. B
Huntsville, Texas 77320

Email:  cmchealthservicesarchives@utmb.edu  Fax:  936-439-1350

Deceased Inmate:

Requests for PHI for deceased TDCJ inmates:
Please contact the Death Records Coordinator at (936) 439-1341, or mail a request in writing to:

Health Services Archives
Attn: Death Records Coordinator
262 FM 3478 Ste. B
Huntsville, Texas 77320

Upon receipt or notification of request, the requestor will be sent an Affidavit of Personal Representative form. The form must be completed, notarized and returned prior to any release of protected health information.  A fee for copies of the PHI may apply.

UTMB TDCJ Hospital Galveston PHI:

Requests for PHI created at TDCJ Hospital Galveston during the inmate’s incarceration must be sent to the UTMB Health Information Management Department in Galveston. 

Phone:  409-772-1965     Fax: 409-772-5101