Information for Submitting Requests

This website allows you to submit requests for copies of a patient's medical records for electronic delivery. Please read the important notes below before continuing to use this system:

  1. This website is designed for parties authorized to make medical decisions for the patient (e.g. parents, guardians, personal representatives) to request records to be delivered electronically through the web. Patients or other parties requesting medical records through this website should click here to review other options for submitting their request.
  2. In order to protect the patient's privacy and comply with federal and state regulations, we need a copy of your driver's license or other government-issued ID as well as proof you are authorized to make medical decisions for the patient before we can release records. Failure to upload all required documents through this system within 72 hours after beginning the process will result in your request being canceled or delayed.
    • If you are on a mobile device (e.g. smartphone/tablet), you will need to electronically sign an authorization form and submit a picture of yourself holding your government-issued ID.
    • If you are on a non-mobile device (e.g. desktop/laptop computer) you will need to print, manually sign, and upload a scanned copy of an authorization form as well as your government-issued ID.
  3. You will also need to submit a legible image (picture or scanned) of proof you are authorized to make medical decisions for the patient. Click here for examples.
  4. Information requested through this system must exactly match hospital records. Typographic errors, such as patient name misspelling or incorrect dates of service, may result in your request being canceled or delayed.
  5. You may be charged a processing fee of 25 cents per page (if copied from paper records) or $25 (if created from electronic records) before delivery of your records. By submitting your request through this system, you agree to pay any processing fees up to and including $50 without prior notification. If your request will incur fees in excess of $50, you will be notified in advance and have the option to cancel your request. You must pay this fee by credit card in order to use this system.
  6. Copies of diagnostic imaging cannot be requested through this system. If you require copies of diagnostic imaging, contact the radiology department at 510-428-2010.

If you are a third party or you will not be able to electronically submit the required documents, please refer to this page to review other options for submitting your request.

Acceptable forms of supporting documentation are listed below. However, the facility where the records you are requesting are located may have additional or other requirements.

Note: Please understand until we have the opportunity to review the request against the medical records, we do not know if additional documentation will be required. You will be notified if we need further documentation.

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