Wadley Health System

Documents and Forms

Request for Medical Records

You have two options for obtaining copies of your medical records:

Option 1
Ask your physician's office to request the desired copies directly through our Medical Records Department.

Phone (903) 798-7100. Fax (903) 798-7119.

There will be no charge for copies requested through a physician's office.

Option 2
To obtain the copies directly yourself, you will need to either mail or fax a copy of the "Patient Authorization Form for Inspecting and Copying Health Information" form to our Medical Records Department. The entire form MUST be completed.

- Patient Authorization Form for Inspecting and Copying Health Information

Please mail the request to:

Wadley Regional Medical Center
Attn: Medical Records Dept.
1000 Pine St.
Texarkana, TX 75501

If you are faxing, please send it to 903-798-7119.

There is a $10.00 charge for the first 5 pages and $.50 for each additional page. There will be additional charges for mailing. Once our Medical Records Department receives your request, they will contact you with the total amount.

Birth Certificate Request

To obtain a copy of a birth certificate you will need to contact:

City of Texarkana, Texas
City Secretary's Office
P.O. Box 1967
Texarkana, TX 75504

Phone number (903) 798-3900

Please be advised the City of Texarkana Texas charges $23.00 for a certified copy.
(Allow two weeks for filing, from date of birth.)

Complete the application below and return it to the address provided. Requires Adobe Acrobat Reader.

- Application for Certified Copy of Birth Certificate

Patient Materials

Personal Pocket Medication Card - Use our Personal Pocket Medication Card to help keep track of your medications easily. When folded, it's the size of a business card and conveniently fits in your purse or wallet. Bring your pocket medication card to visits to your doctor and pharmacist and for hospital stays; and carry it with you at all times in case of an emergency. Be sure your card is updated at the end of your visit or discharge.

- Personal Pocket Medication Card

Privacy Notice - This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Requires Adobe Acrobat Reader.

- Joint Notice of Privacy Practices

Patient Rights - What you need to know about your rights as a patient. Requires Adobe Acrobat Reader.

- Patient Rights- What you should know

Advance Directives - What you need to know about living wills and other advanced directives. Requires Adobe Acrobat Reader.

- Advance Directives

Patient Handbook - The purpose of this handbook is to help acquaint you with Wadley by providing timely information about the services available to you as a patient.

- Patient Handbook

Pre-Registration Form - This form should be completed and submitted prior to admission. Click on the link below to be taken to the online pre-registration form.

- Pre-Registration Form

- To obtain a FREE download of the Adobe Reader, click on the icon.