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Patient Request for Medical Records
Release of Information
A patient, or his/her legal representative, may inspect and/or obtain ta copy, or have copies of medical records sent to another facility*.
How To Request a Copy of Your Medical Records
Please call (510) 814-4037 for the Authorization for Disclosure of Health Information Form.
The form must be completed, dated and signed.
We ask that you specify what components of your medical records you wish to obtain. (Often, the discharge summary, operative report and history and physical contain relevant information to suit your needs.)
Download a copy of the Authorization for Disclosure of Health Information Form by clicking HERE.
Requests must be signed specifically if requesting/authorizing the following information:
- Psychiatric Care
- Alcohol/Drug Abuse
Please note we require 3-5 working days to process most requests.
Release of Information Fees
$15 for the first 30 pages.
More than 30 pages, $0.25 per page for copying plus postage and handling.
We require payment before the records are released.
* There is no charge for requests faxed or mailed directly to another health care facility or physician for the purpose of continuity of care.
Once your form is completed, please deliver, FAX, or mail the form to:
Health Information Management Department (old bldg.)
2070 Clinton Avenue
Alameda, Ca 94501
ATTENTION: Release of Information Office
FAX: (510) 814-4352
Please be sure to note a day-time phone number where you can be contacted.
QUESTIONS? We are happy to help!
Call (510) 814-4037 or (510) 814-057, then press 2.
HOURS: Monday - Friday, 8 a.m. - 5 p.m.