The Owner of Record may use this form to authorize a Third Party to process and pick up. Pre-Application Platting Guidelines.We provide authorized access to patients' medical record information. We also provide general assistance in answering questions about medical record privacy. Complete the Texas standard prior authorization request form (PDF). Then, fax the form to 1-866-835-9589. Authorization to fill in and submit any application or other information. Pursuant to Chapter 40B regulations, the Board would be required to open the public hearing on this application with in thirty (30) days. Give us a call today at 817-413-4000, use our online chat, or fill out the form below! If you would like to view our locations, click the button below.