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UCLA Obstetrics and Gynecology

UCLA Obstetrics and Gynecology

UCLA Obstetrics and Gynecology
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Medical Records

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Authorization for Release of Health Information

How Can I Obtain My Medical Records?

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.

More info on uclahealth.org »

or
#2 Download, Complete & Send Form

Please download the Medical Release Form and return the completed form to the Medical Records Department for processing.
In English | In Spanish

Download and Complete Form (PDF)

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

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