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Medical Records
Release of InformationA patient, or his/her legal representative, may inspect and/or obtain a copy, or have copies of medical records sent to another facility.
Stanford Hospital & Clinics requires a completed and signed written request and authorization for release of health information form before releasing any documents to anyone, including the patient.
In certain cases, a patient’s physician, psychologist or social worker may also be required to approve a request.
To Request a Copy of Your Medical Records
- Print and complete the Authorization for Disclosure of Health Information form
- The form must be completed, dated and signed
- We ask that you specify what components of your medical records you wish to obtain. Often, the discharge summary, operative report and history and physical contain relevant information to suit your needs.
- Requests must be specifically signed if requesting/authorizing the following information:
o Psychiatric Care o AIDS/HIV o Alcohol/Drug abuse o Fertility Treatment
- If you have any questions regarding release of health information, please call (650) 723-5721.
To submit your request once your form is completed:
Please bring form to: Medical Records Department Release of Information Office Room HC029 Ground Floor of the Main Hospital Hours: Monday – Friday, 8:00am – 5:00pm Closed on holidays
Directions and Parking
Mail form to: Stanford Hospitals & Clinics 300 Pasteur Drive, HC029 Release of Information Stanford, CA 94305-5200
Fax form to: (650) 725-9821 Attn: Release of Information
Release of Information Charges
- $0.25 per page for copying plus postage and handling
- If your charges exceed $100, we require payment before the records are released.
- There will be no charge if request is going to another health care facility to maintain continuity of care.
Additional Information
- If an individual other than the patient is picking up the records, then that individual must have an original signed authorization letter from the patient and along with a photo ID.
- Please allow up to 15 working days for your request to be processed. If you indicated the option to pick-up, you will be contacted by the Release of Information Office when your records are ready. A photo ID is required.
Billing
Radiology Images If you are requesting radiology images, telemetry tapes or photos, you must contact the department that collected the data.
- To obtain a copy of these records, please print and complete a separate Authorization for Disclosure of Health Information form
- You can contact:
o The Radiology Film/CD Library by calling (650) 723-6717 o EKG Film Library by calling (650) 723-7407 o The Pathology Slides Library by calling (650) 723-7211
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| | Stanford Hospital & Clinics 300 Pasteur Drive Stanford, California 94305 (650) 723-4000 Legal Notices and Disclaimer
Copyright 2001-2008 Stanford Hospital & Clinics. All rights reserved.
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