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  • Authorization For Use And Disclosure Of Health Information. Release Of Information For The Palo Alto Medical Foundation 2020

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Questions & Answers

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Contact support

Submit directly to SFGH Medical Group (CPG) via email at sfghmedicalgroup@ucsf.edu or via phone at (415) 502-8162.

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.

I was treated in your office [at your facility] between [fill in dates]. I request copies of the following [or all] health records related to my treatment. [Identify records requested, e.g. medical history form you provided; physician and nurses' notes; test results, consultations with specialists; referrals.]

Section 123110 of the Health & Safety Code specifically provides that any adult patient, or any minor patient who by law can consent to medical treatment (or certain patient representatives), is entitled to inspect patient records upon written request to a physician and upon payment of reasonable clerical costs to make ...

By email: PRA@dmhc.ca.gov. By mail: Department of Managed Health Care, attn: Office of Legal Services, 980 Ninth Street, Ste. 500, Sacramento, CA 95814. By fax: (916) 322-9430.

3 . Medical Records: *Guidance from the UCSF Health Information Management Services (HIMS) Department states the retention period for medical records as 15 years following last recorded activity, with records of minors set at 15 years plus three years past the age of majority. 4.

You can view them online or request electronic copies if you get care at a Kaiser Permanente medical office. You can also request your health information be sent to any person or entity. If you get care from a non-Kaiser Permanente provider, contact them to get copies of your record, or to have your record transferred.

Contact Us Hospital Billing (855) 398-1633.

Section 123110 of the Health & Safety Code specifically provides that any adult patient, or any minor patient who by law can consent to medical treatment (or certain patient representatives), is entitled to inspect patient records upon written request to a physician and upon payment of reasonable clerical costs to make ...

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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