UCLA Campus    |   UCLA Health    |   School of Medicine Translate:
UCLA Health It Begins With U

How can I obtain my medical records?  Request for Medical Records

1. Download and print the Authorization for Release of Health Information form below
   

Request by Patient for Access to their Medical Records

Authorization for Release of Information to 3rd Party (Non-UCLA Provider, Insurance Company, Attorney, etc)

2. Complete and sign the form

3. Fax or mail the completed form to the address or fax number below. You may also complete the authorization form in person at our office during business hours.

Please note: Unsigned and/or incomplete requests cannot be processed.

How can I request an amendment to my record?

1. Download and print the Request to Amend Protected Health Information form below
   

Request to Amend Protected Health Information

2. Complete and sign the form

3. Fax or mail the completed form to the address or fax number below. You may also complete the authorization form in person at our office during business hours.

Please note: Unsigned and/or incomplete requests cannot be processed.

Mailing Address

Send a written authorization request to have your medical records copied or inspected to:

UCLA Health
Health Information Management Services
10833 Le Conte Ave., CHS - Suite BH-225
Los Angeles, CA 90095

Fax Number

Patient & Treatment Requests: (310) 983-1458
All Other Requests: (310) 983-1468

Contact Information

Phone Inquiries  (310) 825-6021
Business hours: Monday - Friday 8:00 am-4:30 pm
www.uclahealth.org/medicalrecords 

Patients seen by providers in private practice will need to contact those offices directly to obtain their medical records.

Quick Links

Frequently Asked Questions »

Directions to our Office »