Permission to Release Health Information

The Texas Medical Records Privacy Act (TMRPA) protects patients’ personal health information (PHI) by guaranteeing that patients know how their PHI will be used and shared and prohibits organizations and providers from using or disclosing PHI without their consent. All patients also have the right to revoke permission to release and review their protected health information at any time. This template complies with the requirements of the TMRPA and can be used when a CASA volunteer needs a parent or caregiver’s permission to access their protected health information from DFPS, Community Based Care, service providers or others who may have protected health information relevant to the child’s best interest. Always provide a copy of the Permission to Release Health Information to the person granting the permission.

Download the Printable, Customizable, or Form versions in English and Spanish below: