Patient Forms

These forms have been posted for your convenience. Please print the attached forms, fill them out, and bring them with you to your next doctor or hospital visit. If you have questions, please call our Patient Advocate at (817) 255-1194.

Advanced Directive

• Advance Directive (Living Will)
• Medical Power of Attorney
• Allow Natural Death (Do Not Resuscitate Form)

En Espanol

• Consentimiento de Tratamiento Medico (Testamento en Vida)
• Declaracion Referente al Poder Medico

Looking to obtain a copy of your medical records?

We offer two ways to access your medical record:

MyHealthOne Portal

MyHealthOne consolidates many common tasks into one secure, easy-to-use online patient portal. It gives you access to most of your medical records on your desktop computer, laptop, tablet or smartphone 24 hours a day.

*Note that some medical records may only be available through our hospital Medical Records office.

Access Patient Portal

Access to hard copies of medical records

To obtain a copy of your medical records, please complete, sign and date the medical records release form below and provide a legible copy of your valid photo I.D (e.g. driver’s license, military I.D or state I.D).

Upon completion submit the form using one of the options below:

Patient requests:

• Email to: Para.hscexternalreq@hcahealthcare.com
• Fax to: (844) 481-0298
• Mail to: P.O. Box 290789, Nashville, TN 37229-0789
• For questions, please call: (844) 481-0278

Non-patient requests (attorney, insurance, disability and third-party requests):

• Email to: Para.hscexternalreq@hcahealthcare.com
• Mail to: P.O. Box 290489, Nashville, TN 37229-0489
• For questions, please call: (888) 749-7952

Urgent requests and Continuity of Care records for your physician:

For immediate continuity of care, your healthcare provider can request records.

The physician’s office must fax or email a written request on their letterhead or fax coversheet indicating the patient’s name, date of birth and date of visit in the facility.

If the record is needed urgently, please note STAT on the request.

• Fax to: (469) 484-2006

Certified Birth Certificates

When a child is born at Medical City North Hills, we submit the Birth Certificate information to the Bureau of Vital Statistics. Certified Birth Certificates can only be obtained through the Bureau of Vital Statistics, which is part of the Texas Department of State Health Services. The hospital does not have a certified copy on file.

Obtaining a Certificate

For parents, or patients over the age of 18, to obtain a Birth Certificate, an application must be submitted to the Bureau of Vital Statistics.