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Health Records |
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Confidentiality
All patient information is confidential and protected by privacy laws. Information from your records will
not be released to anyone without your written authorization, except as required by law. Our Notice of Privacy Practices describes how medical information about
you may be used and your rights as a patient.
Retention of Medical Records
The Student Health Center retains patient medical records for a minimum of 10 years from the date of
last visit. Active records are on file at the Student Health Center for a minimum of 2 years. Records of patients
whose most recent visit is more than 2 years from the current year are maintained in our off-site storage
facility.
Requesting Copies of Medical Records
Requests for copies of medical records must be in writing and should be made in advance of the time or date on which you need them.
Please Note: A reasonable cost-based fee may apply (see Charges for Medical Record Services below).
Fees must be paid in advance before records are released.
- To obtain a copy of your medical record for yourself, download, print, complete and sign the following request
form and return it to the Student Health Center in person, by fax or by mail: Request for Access to Medical Record
- To request a copy of your medical record to be sent to a third party, such as another healthcare provider,
attorney, or insurance company, download, print, complete and sign the following authorization form and return it
to the Student Health Center in person, by fax or by mail: Authorization for Release of Health Information
- Release of HIV test results must be authorized separately from authorization for release of other medical records.
To authorize the release of HIV test results, download, print, complete and sign the following authorization form and
return it to the Student Health Center in person, by fax or my mail: Authorization to Release HIV Test Results
Charges for Medical Record Services
- A fee of $20 will be charged for copies of medical records, in whole or in part.
- A fee of $20 will be charged for retrieval of inactive records from off-site storage (+$20 for copies of records)
Note: The retrieval fee for inactive records must be paid in advance before the record will be requested from our off-site storage facility.
- Copies of medical records will be sent to another healthcare provider free of charge as a professional courtesy.
- There is no charge for copies of selected reports. Those reports, when requested singly, include: ($20 retrieval fee
may still apply)
- Immunization record
- Physical examination record
- Laboratory report
- X-ray report
Additional Information
For help in completing authorization forms or any other questions, please contact the Medical Correspondence Desk at (949) 824-9634.
