The releasor authorizes his/her employer to release employment references including, but limited to, his/her employment history and wages and any information which may be requested relative to his/her employment, employment applications, and other related matters, and to furnish copies of any and all records which the employer may have regarding his/her employment.
Release Of Information In In Los Angeles
Category:
State:
Multi-State
County:
Los Angeles
Control #:
US-00458
Format:
Word;
Rich Text
Instant download
Description
Form popularity
FAQ
The most common Children's Hospital Los Angeles (CHLA) email format is first. last (ex. jane.doe@chla), which is being used by 99.0% of Children's Hospital Los Angeles (CHLA) work email addresses.
Obtaining Your Medical Records Log in to myUCLAhealth portal. (Request for medical records can only be accessed via PC, mobile devices are not supported at this time) Follow instructions using links below: Request Your Medical Records. Download Your Requested Medical Records.
Please email the form and legal documentation to himrequest@chlac. Your request will be processed within 48 business hours. If you have any further questions, you may email himrequest@chlac or call 323-361-2330.
You may be able to request your record through your provider's patient portal. You may have to fill out a form — called a health or medical record release form, or request for access—send an email, or mail or fax a letter to your provider.
The best way to get copies of your medical records is in My Health Connection . Log in, go to the “Share my record” section in the menu, then click on “Request formal copy of health record”.
Medical Records. 4401 Penn Ave. If you have questions, please contact us at 412-692-6834 or by e-mail at RecordRelease@chp. Visit our Health Information Management Services to learn more about requesting medical records and fees for those requests.
About UCLA Health UCLA Health comprises four hospitals on two campuses: Ronald Reagan UCLA Medical Center, UCLA Mattel Children's Hospital and the UCLA Resnick Neuropsychiatric Hospital on the university's main campus in the Westwood area of Los Angeles; and UCLA Santa Monica Medical Center.
For assistance, call 714-456-5670, press option 5, followed by option 2.
Option 1: Request medical records via your myUCLAhealth account Log in to myUCLAhealth portal. (Request for medical records can only be accessed via PC, mobile devices are not supported at this time) Follow instructions using links below: Request Your Medical Records. Download Your Requested Medical Records.
