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Medical Records: Release Form & FAQs | UCLA Health
Medical Records: Release Form & FAQs | UCLA Health
Medical Records
We are here to provide you with your medical records, and strive to fulfill your request timely while ensuring your privacy. The following information will help guide you in the options available and provide FAQs and contact information if you have any questions.
Get the help you need
Obtaining Your Medical Records
Contact Information
STAT Request
Request Additional Information
Requests to Amend your Medical Record
Frequently Asked Questions
Pay Invoice
Obtain Medical Records for Resnick Neuropsychiatric Hospital (RNPH), Behavior Health Services and Counseling and Psychological Services (CAPS).
To request student medical records for visits that occurred at CAPS prior to July 8, 2025, please contact their
medical records department
Quick Links
Authorization for Release of Health Information - English
Autorización para la Divulgación de Información Médica - Spanish
Request to Amend Protected Health Information (PHI) Form
STAT Request
If you are a patient looking for medical records from UCLA West Valley Medical Center for services rendered prior to March 11, 2025, please access the MyHealthOne Portal.
To request student medical records for visits that occurred at Arthur Ashe Student Health and Wellness Center prior to July 8, 2025, please contact their
medical records department
Obtaining Your Medical Records
Option 1:
Request medical records via myUCLAhealth or MyStudentChart
Requests can only be accessed via PC. Mobile devices are not supported at this time.
1. How to submit a request for your medical records via:
myUCLAhealth (for UCLA Health records)
If you have not signed up for myUCLAhealth, go to
How to Sign Up for myUCLAhealth
for instructions.
Log in to
myUCLAhealth
To request your medical records, follow the steps outlined
here
For instructions on how to download requested records, click
here
For assistance with your myUCLAhealth account, call
855-364-7052
MyStudentChart (for Arthur Ashe Student Health and Wellness Center and Counseling and Psychological Services (CAPS) records)
Log in to
MyStudentChart
For instructions on how to request your medical records, click
here
For assistance with your MyStudentChart account, call
310-825-4073
(Option 8).
Option 2: Follow this link to complete the medical record authorization form electronically.
Have your photo identification ready and follow the prompts.
Once completed the form will be sent to our HIM team directly.
Click Here to Request Medical Records Online
Option 3: Download and print the authorization for Release of Health Information form.
Download and print the authorization form for Release of Health Information for Patient or a third-party (i.e. Non-UCLA Provider, Insurance Company, Attorney, etc.).
Authorization for Release of Health Information - English
Autorización para la Divulgación de Información Médica - Spanish
Complete and sign the form.
Please Note: electronic signatures are not accepted at this time.
Submit completed form via email, fax, or mail.
Email:
[email protected]
Fax:
310-983-1468
Mail:
UCLA Health
Health Information Management Services
10833 Le Conte Ave., CHS, BH-902
Los Angeles, CA 90095
Please note: Unsigned and/or incomplete requests will not be processed and will be returned to requestor.
Medical Record Copy Fee
UCLA Health will invoice you for the production of records, and will invoice you by mail/email. Please see our
Frequently Asked Questions
Contact Information
Business Hours:
8:00 am to 4:30 pm, Monday to Friday
Phone:
310-825-6021
Fax:
310-983-1468
Email:
[email protected]
Mailing Address:
UCLA Health
Health Information Management Services
10833 Le Conte Ave., CHS, BH-902
Los Angeles, CA 90095
STAT Request
(For physicians and hospital use only)
If you are a physician or hospital and your request is urgent, please fax your request to 310-206-4831.
Requesting Additional Information
If you are requesting additional information such as radiology imaging, pathology slides, or billing information, please contact the corresponding department below directly:
Radiology Imaging –
310-825-6425
Pathology Slides –
310-825-8947
Cardiac Imaging –
310-267-5994
Hospital Billing Records –
310-825-8021
Outpatient Billing Records –
310-301-8860
Request to Amend your medical record
Option 1:
Request to amend or add an addendum to your health record via myUCLAhealth or MyStudentChart
Requests can only be accessed via PC. Mobile devices are not supported at this time.
1. How to request an amendment or add an addendum to your health record via:
myUCLAhealth (for UCLA Health records)
Log in to
myUCLAhealth
and complete the online form.
For assistance with your myUCLAhealth account, call
855-364-7052
MyStudentChart (for Arthur Ashe Student Health and Wellness Center and Counseling and Psychological Services (CAPS) records)
Log in to
MyStudentChart
For instructions on how to submit a request, click
here
For assistance with your MyStudentChart account, call
310-825-4073
(Option 8).
Option 2: Download and print the amendment form to Request to Amend Protected Health Information (PHI)
Download and print the
Request to Amend Protected Health Information (PHI) form
Complete and sign the form.
Please note: electronic signatures are not accepted at this time
Submit completed form via email, fax, or mail.
Email:
[email protected]
Fax:
310-794-1616
Mail:
UCLA Health
Health Information Management Services
10833 Le Conte Avenue., CHS BH-921
Los Angeles, CA 90095
For additional information, visit our
Frequently Asked Questions