STATE OF CALIFORNIAAUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATIONDEPARTMENT OF CORRECTIONS AND REHABILITATIONCDCR 7385 (Rev. 11/14)Form: Page 1 of 2 Instructions: Pages 3 & 4All sections.

How it works
  • Open form

    Open form follow the instructions

  • Easily sign form

    Easily sign the form with your finger

  • Share form

    Send filled & signed form or save

How to fill out the Cdcr 7385 Form online

Filling out the Cdcr 7385 Form online is a straightforward process that allows for the easy authorization of the release of protected health information. This guide provides clear, step-by-step instructions to assist users in completing the form accurately.

Follow the steps to successfully complete the online Cdcr 7385 Form.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. In the 'Patient Information' section, provide the last name, first name, middle name, CDCR number, date of birth, and address. Use 'N/A' if certain information is not applicable.
  3. Under 'Individual/Organization Authorized to Release Personal Health Records if Other Than CDCR', enter the name and address of the individual or organization permitted to release the health records.
  4. In the 'Individual/Organization to Receive the Information' section, fill in the name, relationship to inmate, address, city/state/zip, phone, and fax of the person or entity receiving the information.
  5. For the 'Authorization Expiration Event or Expiration Date for Release of Verbal Information/Written Correspondence', select the expiration choice: date, release from custody, or conclusion of an event, and fill in the necessary details.
  6. In 'Hardcopy Health Care Records to be Released', specify the date range for the health care records requested and check the relevant boxes to indicate the types of information to be released.
  7. In the 'Purpose for the Release or Use of the Information' section, check at least one box or select 'Other' to describe the purpose for the release.
  8. Review the 'Authorization Information' carefully. Ensure that you understand your rights regarding the release of your health information.
  9. Finally, in the 'Patient Signature' section, print your name, sign, and date the form. If completing the form on behalf of another person, ensure to include your relationship to the patient and necessary supporting documents.
  10. After filling out the form, save your changes, and use the options to download, print, or share the completed form as needed.

Complete your Cdcr 7385 Form online to ensure a seamless authorization process.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Related content

CDCR 7385 - English

... RELEASE OF PROTECTED HEALTH INFORMATION. CDCR 7385 (Rev. 11/14). DEPARTMENT OF...

Learn more
Patient-Inmate Orientation Handbook to Health Care...

related appeals you file on CDCR Form 602-HC, Inmate/Parolee Health Care ... If your past...

Learn more
San Joaquin County, California - Wikipedia

San Joaquin County officially the County of San Joaquin is a county in the U.S. state of...

Learn more
Questions & Answers

Get answers to your most pressing questions about US Legal Forms API.

Contact support

How long are medical records kept in California?

1. How long must medical records be retained under California law? In short, medical records must be retained at a minimum for seven (7) years in compliance with state law.

Mail to Health Records Center, P.O. Box 588500, Elk Grove, CA 95758; alternatively, faxed (916) 229-0002 or releaseofinformation@cdcr.ca.gov.

CDCR 7385, Authorization for Release of Protected Health Information.

To request review or release of your CDCR health care records or information, you should complete a CDCR Form 7385 (Authorization for Release of Protected Health Information). A copy of the 7385 form is attached to this letter. You should do your best to fill out all sections of the 7385 form.

You can make a written request to either review or obtain a copy of your medical records pursuant to Health and Safety Code sections 123100 through 123149.5. You can view these laws on the California Legislative Information website.

This California HIPAA release form enables patients to permit any person or 3rd party organization to have access to their personal health records. The HIPAA release form also optionally allows healthcare providers to share health information with each other.

CDCR Main Number: 916-324-7308 If you are looking for specific contact information click a subject below.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

If you believe that this page should be taken down, please follow our DMCA take down process here.

Get Cdcr 7385 Form