Request for Release of Health Information
Requesting medical health records? Review all options before selecting one of the following:
UCR Student Health Services
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 visit our UCR Student Health Services.
PLEASE NOTE: UCR Health is NOT UCR Student Health Services
Authorization for Release of Health Information
I am a current or past patient of UCR Health, provider or hospital
- Download, complete and sign the UCR Health Authorization for Release of Health Information form.*
- 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. **
| roiucrhealth@medsch.ucr.edu | |
| Fax | (951) 344-5362 |
| 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 |
* If you are not able to download and print the appropriate form, stop by any UCR Health location to pick up the correct form
** Please allow 2 weeks for processing authorized requests
Authorization to Obtain Health Information
I am a new, referred, or transferred patient to UCR Health
- Download, complete and sign the UCR Health Authorization to Obtain Information from Outside Health Care Providers form.*
- 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. **
| roiucrhealth@medsch.ucr.edu | |
| Fax | (951) 344-5362 |
| 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 |
* If you are not able to download and print the appropriate form, stop by any UCR Health location to pick up the correct form
** Please allow 2 weeks for processing authorized requests
I am an Attorney, Copy Service, or Insurance Company
If you are requesting medical and/or billing records, please include a $15.00 processing fee per item requested (check only) made payable to Regents UC and serve the request:*
| UCR Health ATTN: Medical Records – Mail Code 423 900 University Avenue Riverside, CA 92521 |
* Please allow 2 weeks for processing authorized requests
PLEASE NOTE: UCR Health will not have Diagnostic Imaging. UCR Health patients are referred to imaging centers
Other
| Questions | For questions regarding submitted requests, please call 1.951.715.7209 |
| MyChart Patient Portal | You may also access and review your test results, upcoming appointments and communications with your provider by accessing MyChart Patient Portal. |
| Compliance Office | Additional access to your records can be scheduled through the Compliance Office by calling 951.827.4672. |
Health Information Management Office
UCR Health
ATTN: Medical Records – Mail Code 423
900 University Avenue
Riverside, CA 92521
Phone: 1.844.827.8000
Fax: 1.951.344.5362
Mon – Fri: 8am to 4:30pm
Sat and Sun: Closed