Request for Release of Health Information

Requesting medical health records? Review all options before selecting one of the following,

I need records from the following facility,

• UCR Student Health Services
• UCR Health – Family Center (Palm Springs, CA)

I Am

• A current or past patient of UCR Health (release)
• A new, referred, or transferred patient to UCR Health (obtain)
• An attorney or copy service
• A physician or hospital (release)
• Other

 

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For any inquiries regarding release of health information from UCR Student Health Services, please contact UCR Student Health Services on UCR Campus at (951) 827-3031.
 
For more information about UCR Student Health Services, please CLICK HERE.
 

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Inquiries for release of health information from UCR Health Family Center (Palm Springs), please contact the office,

• PHONE (760) 561-7373
• FAX  (760) 327-5140

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I am a current or past patient of UCR Health, provider or hospital

STEP 1 - Download, complete and sign form

• Click to download and print the UCR Health Authorization for Release of Health Information form.

• If you are not able to download and print the appropriate form, stop by any UCR Health location to pick up the correct form

STEP 2 - Send in the completed form

• We want to make it easy to submit your completed form. There are 4 ways to get us your completed form.  

E-Mail	roiucrhealth@medsch.ucr.edu
Fax	(951) 344-5362
Mail	UCR Health ATTN: Medical Records - Mail Code 423 900 University Avenue Riverside, CA 92521
Drop Off	UCR Health – Multispecialty Clinic UCR Health – Psychiatry Clinic UCR Health – Neurosurgery UCR Health – Women’s Health UCR Health - Pediatric Clinic