Request Medical Records (Health Information Management)

1.  Write a letter and include

• Patient's Name 
• Patient's Date of Birth
• List of requested information
  (examples of items you might request include:  surgery report, x-ray report, discharge summary, clinic visit notes, history and physical report, etc) 
• Purpose for the request
   (personal use, for your physician, attorney, immigration, court, etc.) 
• Address where the information is to be MAILED
• Contact phone number of legal guardian (and recipient, if different)
• Legal guardian's signature
• Legal guardian's relationship to patient (i.e. parent, grandparent, self)

Please note: If patient is over 18 at the time of the request, the patient must authorize release of their medical records (unless they are physically unable to do so).

2.  Submit your request

Personal:  $0.25 cents per page, plus tax and postage.
Medical:  No cost
Other:  Contact the "Release of Information" Department directly at (323) 361-2387 between 8:30 a.m. - 4:30 p.m. for further details.