Medical Records

Mailing Address

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

Release of Information Customer Service Office

100 Medical Plaza
Suite #140
Los Angeles, CA 90095
Monday-Friday, 8:00 am to 4:30 pm
*Walk in service available.

Contact Information

Telephone Number: (310) 825-6021
Business Hours: Monday – Friday, 8:00 am - 4:30 pm

Fax Number

Please fax authorizations to:
Requests from Patients: (310) 983-1468
Requests from External Providers: (310) 983-1458

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

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

Authorization for Release of Information to a third-Party (a 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 above. 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 above. 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.

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