Medical Records

Your CHC Health Information Team is here to make sure your health data is just as well cared
for as you are. Protecting your privacy is our top priority.

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Information Release Authorization

A parent, client, or their legal representative may inspect and/or obtain a copy of their medical records or have copies of medical records sent to another facility.

Children’s Health Council requires a completed and signed Authorization for Release of Health Information Form before releasing any documents to anyone, including the client. In some instances, a client’s physician, psychologist, or social worker may also be required to approve a request made using a release form.

Under the HIPAA privacy rule, a parent no longer has the right to access their child’s medical information once their child has turned 18 (and is now a legal adult). In this situation, an Authorization for Release of Health Information form will be required to allow us to communicate or release information to the parents.


Request Your Records

For Personal Access or Copies

Parents and Legal Guardians:

To access or receive copies of your child’s medical records, please complete the Medical Records Request Form. This form enables you to directly request and receive the necessary medical records.

 

Adult Clients (18 and older):

Adult clients can directly request their medical records using the Medical Records Request Form for their personal use or review. This form allows you to access your complete medical history and treatment records maintained by CHC. Whether you need your records for personal reference, review, or to share with other healthcare providers.

Medical Records Request Form (English)

Medical Records Request Form (Spanish)

To Authorize Release to Third Parties

Release to a Third Party:

If you wish to have medical records sent to another individual or organization (such as another healthcare provider, school, or legal representative), you must fill out the Authorization for Release of Health Information Form.

 

Adult Clients (18 and older):

Complete the Authorization for Release of Health Information Form to grant CHC permission to disclose your medical records to designated individuals or organizations, including Parents, healthcare providers, schools, or legal representatives.

Authorization of Use and Disclosure Form (English)

Authorization of Use and Disclosure Form (Spanish)

Next Steps after Requesting Your Records

Please allow up to 14 days for your request to be processed. If you indicated the option to pick up your medical records, we will contact you when your records are ready. A photo ID is required. If an individual other than the parent or client is picking up the records, they must have an original signed authorization letter from the client and a photo ID.

Once you have reviewed your records, if you find an error that requires correction, please discuss it with your clinician and review our Notice of Privacy Policy

If you have any questions regarding a request for releases of Medical Records, please contact us.


Questions about your records?

CHC Medical Records

For questions regarding your medical records, please contact the CHC Medical Records Office:

Phone: 650.688.3614
Fax: 650.688.3636
Email: medicalrecords@chconline.org

Voicemail Instructions: Please leave your name, child’s name, and child’s date of birth.

CHC Billing Records

For questions regarding your billing records, please contact the CHC Business Office:

Phone: 408.516.4171
Email: billing@chconline.org

HIPAA & Your Privacy

CHC takes your privacy very seriously and follows all HIPAA regulations. If you have any questions about how we protect, secure and manage your health information, please contact our Chief Compliance Officer at privacy@chconline.org or 650.688.3612.

HIPAA Privacy Notice