Release of Information Authorization Form

ROI Authorization Form

Please complete the attached form in order to request a copy of your medical records. The form may be hand delivered or mailed to Park Plaza Hospital

Attn: Medical Records Dept.
1313 Hermann Drive
Houston, TX 77004

Please include a copy of an official photo ID (ex. drivers license, passport, etc.). If you would like to receive your complete record, please contact the Release of Information Representative at (713) 527-5010.