Medical Records Request

Medical Record Services maintains all records of patients seen in the Primary Medical and Women's Clinics at the Pat Walker Health Center.

With proper authorization, the patient may obtain a copy of his/her medical and/or immunization records for a nominal fee. Request for information are completed upon receipt of an authorization within 7-10 working days.

Because your medical information is confidential and requires high levels of security, an authorization form with your signature on it must be completed prior to processing. There may be charges associated with your request and payment must be made prior to your records being released. Our cashier is located on the 1st floor of the Pat Walker Health Center. We accept cash, check, VISA, MasterCard, Discover and RazorBuck$.

Please make checks payable to University of Arkansas. See below for charges that may apply.

Directions for Completing an Authorization Form

  1. Download the Release of Medical Records Form and print it on any printer. If you encounter problems, please email us at bb025@uark.edu.
  2. Complete authorization form in its entirety. Be sure to sign and date the bottom of the form. If you have any questions on how to complete the authorization form please email us at bb025@uark.edu. If any portion of the form is incomplete, it will be returned to the requester and cause a delay in processing.
  3. Mail or fax authorization form to:
    Pat Walker Health Center
    Medical Records Services/HIM 
    525 N. Garland Ave.
    Fayetteville, AR 72701
    FAX: 479-575-8793

Charges for Medical Records Services:

  • Personal copy of health record: Processing fee $10 in addition to fifty cents (.50) per page for the first twenty-five (25) pages and twenty-five (.25) cents for each additional page. Individual pages: fifty cents (.50) per page for the first twenty-five (25) pages and twenty-five cents (.25) for each additional page.
  • For physicians or medical institutions: No charge - Professional courtesy
  • For attorneys or insurance companies: Processing fee $10 in addition to fifty cents (.50) per page for the first twenty-five (25) pages and twenty-five cents (.25) for each additional page.
  • For AR State Disability: Processing fee $10 in addition to fifty cents (.50) per page for the first twenty-five (25) pages and twenty-five cents (.25) for each additional page.
  • For verification of psychiatric disability: $50
  • For Radiology images: $5
  • Additional microfilm retrieval fee of $10.00 (for any protected health information). 

If you have any questions or concerns please contact Medical Record Services at bb025@uark.edu or call 479-575-4451 and select option 1. Our fax number is 479-575-8793.