To request your medical record, please complete the health information release form (Adobe Acrobat Needed To Download File -- Download Now For Free) and mail to:
Health Information Services
UCSD Medical Center
200 W. Arbor Drive, #8825
San Diego, CA 92103-8825
To contact Medical Records, please call (619) 543-6704.
Records can be released to anyone who the patient authorizes (in writing) to receive such information. This authorization form (PDF, in English and Spanish) can be used to request records for personal use or for continuing medical care. You can submit the same form for our UCSD Medical Center in Hillcrest, UCSD Thornton Hospital, as well as Perlman, Lewis Street, Moores Cancer Center and Scripps Ranch clinic locations.
A valid authorization MUST contain the following information or the request will be returned:
- Patient’s full name and date of birth (list any other names the patient may have had)
- Medical record number (if available)
- Specific information being requested (i.e., type of report/information and dates of service, etc.)
- Purpose for which the information may be disclosed (i.e., personal use, continuity of care, legal matter)
- To whom the information is to be sent (name and address)
- Specify authorization’s expiration date if desired (otherwise, the authorization will be valid one year from date signed)
- The patient’s signature or a patient’s legal representative’s signature. Authorizations signed by a representative must be verified. Please include a copy of one of the following documents indicating either:
- Please note that unsigned requests will not be processed
- Date of the signature
Requests for medical records of deceased patients require a copy of the death certificate or evidence of next of kin or executorship of the estate.
Please also include your phone number in case we need to contact you for additional information concerning your request.
SUBMITTING REQUESTS AND RECEIVING RECORD COPIES FOR PERSONAL USE
Requests for medical records from the UCSD Medical Center in Hillcrest, UCSD Thornton Hospital, and Moores Cancer Center may be mailed or taken to the Release of Information unit of the Health Information (Medical Records) Services Department:
Release of Information, Health Information Services
UCSD Medical Center
200 West Arbor Dr. #8825
San Diego, CA 92103-8825
There is a fee for the copies and processing of the copies if the request is for your personal use.
Please allow reasonable time to process your request. We will contact you in the event we experience unforeseen delays or are unable to fulfill your request. We will either mail it to the address specified on the authorization form, or you may pick them up at our office if you make arrangements with the Release of Information Staff. For security reasons, please be prepared to show proper photo identification.
SUBMITTING REQUESTS FOR CONTINUING MEDICAL CARE
Medical emergencies will be faxed free of charge directly to a physician or medical facility.
Continuing care requests are also free of charge and will be mailed to your clinic/physician(s) prior to your appointment (please indicate the date of your appointment on the authorization form so that the copies are received early enough for your physician to review). Pertinent information such as radiology/imaging, history and physical, consultations, operative reports, and discharge summaries are routinely provided to the physician for continuing care.
SUBMITTING REQUESTS FOR OUTPATIENT VISIT RECORDS (Perlman/Lewis St/ Scripps Ranch clinic locations) — for Personal Use and Continuing Care
You can mail or take your request for your outpatient clinic records to the Health Information (Medical Records) Services Department at the Clinic sites listed below:
- Fourth and Lewis Medical Office
330 Lewis Street, Mail Code 8201-A
San Diego, CA 92103-8201
- Perlman Ambulatory Care Center
9350 Campus Point Drive, Mail Code 0977
La Jolla, CA 92037-0977
- Scripps Ranch
9909 Mira Mesa Blvd., Suite 200, Mail Code 8217
San Diego, CA 92131-8217
Please allow reasonable time to process your request. Fees will also be applied for ‘personal use’ requests. Requests for records to be mailed to physicians or clinics for the purpose of continuing care will be provided at no charge.
When picking up copies of your records, please provide proper photo identification.
SENSITIVE INFORMATION
Certain information requires a special authorization covering sensitive information. This includes psychiatric, drug and/or alcohol abuse, HIV/AIDS, genetic testing. Authorizations for sensitive information must specifically refer to the information that is to be released.
REQUESTS FOR X-RAY FILMS
Please contact our Radiology/Imaging Department for films, at
- (619) 543-6586 (UCSD Medical Center, Hillcrest)
- (858) 657-6646 (UCSD Thornton Hospital, La Jolla)
REQUESTS FOR BILLING INFORMATION
Please contact the appropriate billing office for billing information:
UCSD Medical Center, Hillcrest and UCSD Thornton Hospital, La Jolla - Patient Financial Services:
UCSD Medical Group (Outpatient Clinics) - Physician Billing Offices:
REQUESTS FOR BIRTH CERTIFICATES/DEATH CERTIFICATES
Please contact the County of San Diego at www.sdcounty.ca.gov/arcc/services/birthdeath_certificates.html