Request for Release of Health Information

If you wish to authorize the release of your health information (medical records) please complete the UCR Health Authorization for Release of Health Information form which may be obtained from your healthcare provider or can be downloaded here. When completing the form, please mark only the information that you wish to be released.

Return the completed authorization to one of the following:

  • Your physician’s office
  • Mail to:
    University of California Riverside
    Attention Compliance
    14350-2 Meridian Parkway
    Riverside, CA 92508
  • Fax to:

Authorized requests will be forwarded to HealthPort for processing. Please allow 2 weeks.

Questions regarding submitted requests will be handled by HealthPort. Please call 800.367.1500 for assistance.