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Authorization for Release of Medical Record InformationTo request a copy of your UC Irvine Healthcare medical records, simply download, print, complete and sign the following authorization forms.
You will need the Adobe® Reader®to view and print the following documents from your desktop. If you do not have this software, you may download it free from Adobe's website. Once you have completed the authorization forms, you may fax them to 714.456.7576 or mail them to Medical Correspondence at the address below. Please be sure to sign the forms before returning them. Unsigned requests cannot be processed. Medical Correspondence For patients of Gottschalk Medical Plaza in Irvine, fax all medical record authorization forms to 949.824.1733. If you need to speak with someone for further assistance, please call 949.824.3488. Patients of the Anaheim or Santa Ana Family Health Centers, Beckman Laser Institute & Medical Clinic or Manchester Pavilion in Orange should contact those facilities directly. There is a $0.25 per page copying fee if the requested records are for your personal use. Requests are processed and fulfilled within 10 working days after they are received. We will either mail the records to the address specified on the authorization form or you may pick up your copy at office located at the address above Monday through Friday from 8 a.m. to 4:30 p.m. To contact Medical Correspondence directly, please call 714.456.5670. |
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