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  • Ca Chla Consultation Request Form 2016

Get Ca Chla Consultation Request Form 2016-2025

Children s Hospital Los Angeles Department of Pathology & Laboratory Medicine Ship To: Department of Pathology and Laboratory Medicine Children s Hospital Los Angeles 4650 Sunset Blvd. MS #43 Los Angeles, CA 90027 4650 Sunset Blvd. MS #43 Los Angeles, CA 90027 Phone: 323-361-2469 Fax: 323-361-8004 CONSULTATION REQUEST FORM Please use one form per case to include: 1) Cover letter containing a summary of the clinical history 2) A copy of the surgical pathology report, even if incomplete Ref.

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If you are interested in obtaining a copy of your medical records, please contact the student health center health information management on (213) 740-0206 or fax (213) 740-4961. How long do you retain medical records? Our policy is to retain medical records for a minimum of 10 years.

California Law Requires a Written Request to Your Doctor After the doctor receives your request, the doctor must provide you with a copy of your medical records within 15 days.

Please email the form and legal documentation to himrequest@chla.usc.edu. Your request will be processed within 48 business hours. If you have any further questions, you may email himrequest@chla.usc.edu or call 323-361-2330.

Records should be kept to 10 years after the patient turns 18 years old. Per CMA, “in no event should a minor's record be destroyed until at least one year after the minor reaches the age of 18.” Records of pregnant women should be retained at least until the child reaches the age of maturity.

HSC section 123145 indicates that providers of health services that are licensed under sections 1205, 1253, 1575, or 1726 shall preserve the records for a minimum of seven years following discharge of the patient.

Hospital Los Angeles, Health Information Management, 4650 Sunset Blvd, MS #46, Los Angeles, CA 90027, Fax: (323) 361-1106.

If you qualify for Charity Care, CHLA will waive the full amount of your hospital bill for emergency or medically necessary services. If you qualify for Discounted Care, CHLA will offer you a discount on your hospital bill for these services.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232