Option #1 - Send Written Authorization to UCLA Health Information Management Services.
or...
Option #2 - Download, complete and send form to UCLA Health Information Management Services.
#1 Send Written Authorization
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 Numbers
Patient & Treatment Requests:
(310) 983-1458
All Other Requests:
(310) 983-1468
Contact Information
Phone Inquiries (310) 825-6021
Hours: Monday - Friday 8:00 am-4:30 pm
Patients seen by providers in private practice will need to contact those offices directly to obtain their medical records.
Please download the Medical Release Form and return the completed form to the Medical Records Department for processing.
In English | In Spanish
Send to:
UCLA Health
Health Information Management Services
10833 Le Conte Ave., CHS - Suite BH-225
Los Angeles, CA 90095
Fax Numbers
Patient & Treatment Requests:
(310) 983-1458
