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

  1. Download, complete and sign the UCR Health Authorization for Release of Health Information form.*
  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. **  
Emailroiucrhealth@medsch.ucr.edu
Fax(951) 344-5362
MailUCR Health
ATTN: Medical Records – Mail Code 423
900 University Avenue
Riverside, CA 92521
Drop OffUCR 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

  1. Download, complete and sign the UCR Health Authorization to Obtain Information from Outside Health Care Providers form.*
  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. **  
Emailroiucrhealth@medsch.ucr.edu
Fax(951) 344-5362
MailUCR Health
ATTN: Medical Records – Mail Code 423
900 University Avenue
Riverside, CA 92521
Drop OffUCR 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 or Copy Service

If you are requesting medical and/or billing records, please include a $15.00 processing fee (check only) made payable to Regents UC and serve the request:*

In PersonMail
Located in Citrus Tower
UCR Health – Multispecialty Clinic
3390 University Avenue, STE 100
Riverside, CA 92501  
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

QuestionsFor questions regarding submitted requests, please call 1.951.715.7209
MyChart Patient PortalYou may also access and review your test results, upcoming appointments and communications with your provider by accessing MyChart Patient Portal.
Compliance OfficeAdditional 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

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