Breadcrumb Home Support & Information Medical Records FAQ Frequently Asked Questions Sub-navigation Medical Records FAQ ROI Request Status (Download FAQ as PDF) FAQ for Release of Information | Medical Record Request FAQ for Other Requests Related to Your Health Record Release of Information | Medical Record Request Is there a fee for patients to receive their own medical records? There is no fee for patients to receive their own medical records. What are your telephone hours of operation? We are open Monday through Friday from 8 am to 4:30 pm at 310-825-6021. How can I submit my request for medical records? MyChart – Patient portal Email – [email protected] Fax – 310-983-1468 Mail – UCLA HIMS Release of Information 10833 Le Conte Ave., BH-902 Los Angeles, CA 90095 How long does it take to fulfill my request for medical records? Requests are processed within 15 business days of receipt. Will you fax the copies to my home or business? No, due to confidentiality reasons we cannot fax to home or business (work) fax numbers. Can anyone other than me request or receive copies of my medical records? Yes, only if the person signing on behalf of the patient has provided legal documentation (i.e. Advance Directive/Power of Attorney) stating that the person making the request is authorized to request and receive the patient’s medical records. How can patients obtain a copy of x-ray film? Contact the Westwood Radiology Film Library Department at 310-825-6425. Contact the Santa Monica Radiology Film Library Department at 424-259-8111. How can I obtain a copy of my billing records/statements? Contact the Hospital Billing Department at 310-825-8021. Contact the Outpatient/Physician Billing Records at 310-301-8860. How can I obtain a copy of my Jules Stein records? Our office will be able to provide your Jules Stein records. However, if you are seeking images please contact Ophthalmology directly at 310-794-7446. How can I obtain a copy of my Dental records? Contact UCLA School of Dentistry at 310-825-3195. dentistry.ucla.edu/patient-care/patient-resources/dental-records How may I obtain records from UCLA Arthur Ashe Student Health and Wellness Center? Contact UCLA Arthur Ashe at 310-825-4073. studenthealth.ucla.edu/contact/medical-records RELEASE OF INFORMATION for Non-Patient/Third Party Requestors What forms of payment do you accept? We accept payments via the "Pay Invoice" websitecommerce.cashnet.com/42859PAY We accept checks and/or money orders by mail. Please make checks payable to UC REGENTS, and mail them to UCLA HIMS Release of Information, 10833 Le Conte Ave., BH-902, Los Angeles, CA 90095 FAQ for Other Requests Related to Your Health Record What are all the options for medical record correction/what forms does Health Information Management Services (HIMS) manage? Patient Amendment – An amendment changes the content of your medical record by the author of the note in question. Patient Addendum – An addendum is an addition to your medical record. It does not delete or change any of the existing information currently in the record. Accounting of Disclosures – An accounting of disclosures compiles a listing of how UCLA Health has released your medical information. UCLA Health does not list disclosures made for TPO (treatment, payment and operations). Statement of Disagreement – A statement of disagreement is much like an addendum, it is added to your medical record to state that you disagree with the outcome of your amendment request. What information needs to be included on the amendment request? Please include the following: What information needs to be corrected (ex: diagnosis, history, visit information…etc.)? Why do you want the information corrected? How do you feel it should be corrected? If you need corrections to a visit, what is the date of service? What is the name of the physician, nurse, or the clinician who entered the information on your record? If applicable, include supporting documents. If this a billing/coding related amendment request, please mark the billing box. How long will it take for my amendment to finalize? We cannot give a definitive answer but a good timeframe is 60 to 90 days. As stated above, the only person who can change the information in your medical record is the author of the note, HIMS cannot. Therefore, we must get in touch with the author and request that they make the changes. Unfortunately, not every author responds in a timely manner, but we do our best to continually keep in contact until we have an answer. How can I submit any of the forms from above? Please print, fill out, sign and date the form in question. Delivery options: By mail: UCLA Health Information Management Services Attention: HIMS Director 10833 Le Conte Ave., CHS BH-921 Los Angeles, CA 90095-7305 Fax: 310-794-1616 Email: [email protected] Make sure to put the form type in the subject line. Can I request that my physician make the changes I am asking for in my amendment at my next office visit? Yes, you may. A physician does not have to go through our formal amendment process to make corrections; however, they may choose to use our process if they feel it is necessary. I have a question on one of these forms, who do I contact? Please email [email protected] with your questions. What are the outcomes for an amendment request? There are three possible outcomes that the author can choose: Approve – The author of the note makes all the changes requested. We will send you a copy of the amended note once it is finalized. Partial Approval – The author of the note makes some of the changes requested but denies the others. We will send you a letter explaining what they have changed along with a copy of the amended note. Denial – The author of the note does not make the changes that the amendment request is asking for. We will send you a letter letting you know of the denial. My amendment was denied, now what? When an amendment is submitted, we get in contact with the author of the record in question, and provide them with all of the information that you have provided us with. The author is the only one who can make the decision. If you do not agree with their decision, please fill out a “Statement of Disagreement” form and submit to HIMS. We will add it to the same date of service as the note in question in the medical record. If you do not wish to submit a “Statement of Disagreement”, please fill out the section on the form titled “I do not want to file a Statement of Disagreement.” We will then upload a copy of your amendment request and the denial letter to the medical record with the same date of service as the note in question. Does UCLA place special restrictions over medical record release? UCLA Health only releases health information with a compliant authorization, keeping the minimum necessary rule in practice and following TPO (treatment, payment, operations) standards. Please call our release of information customer service at 310-825-6021 if you have questions regarding this. How do I set up restrictions on medical record access? You may set up break the glass by contacting the UCLA health patient access services line at 310-267-8000 and selecting option #3 for UCLA Health Admissions.