Facility Medical Record Access Request

Providers and facilities with a signed agreement with UMC Health System can utilize this application to request records for further care and/or placement.

If your office or facility is not yet registered please call UMC Health Information Management at 806-775-9150 between the hours of 8a-5p Monday thru Friday or visit us at 309 North Slide Road in Lubbock.

Patients or family members seeking records may call UMC Health Information Management at 806-775-9150 between the hours of 8a-5p Monday thru Friday or visit us at 309 North Slide Road in Lubbock. This request tool is only for facilities and entities with signed confidentiality agreements with University Medical Center.

Requester Information

Requester Entity(Required)

Requester Name(Required)

First Last

Requester Phone(Required)

Reason for Access(Required)

Reason for Access (Other)(Required)

Patient Information

Patient(s)

Patient Name(Required)

First Middle Last

Patient DOB(Required)