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MEDICAL RECORDS REQUEST

Release of information

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

Alameda County Behavioral Health Care (ACBH) requires a completed and signed Release of Information, Authorization to Disclose Individually Identifiable Health Information form and/or Authorization to Disclose Psychotherapy Notes form before releasing any documents to anyone, including the client.

In certain cases, a client’s clinician, psychologist or social worker may also be required to approve a request made using a release form.

  • Print and complete the Alameda County Behavioral Health Authorization to Disclosure Individually Identifiable Health Information form:
  • Print and complete the Alameda County Behavioral Authorization to Disclosure Psychotherapy Notes form:
  • We ask that you specify what components of your medical records you wish to obtain/release. All requests must be specifically signed if requesting/authorizing the following information:
    • Psychiatric Care
  • The release forms must be completed in its entirety, dated, and signed.
  • If mailing or faxing your request, please provide a copy of a valid government issued ID along with the Authorization Forms.

If you have any questions regarding release of health information from Alameda County Behavioral Health Care, please call 1 (510) 567-6884. You may deliver your forms in person, via fax, or by mail.

Alameda County Behavioral Health Care
Custodian of Records
2000 Embarcadero, Suite 400
Oakland, CA 94606

Fax Requests To: 1 (510) 777-2208

Hours: Monday – Friday, 8 a.m. – 5 p.m. Closed on holidays

 

If you have any questions regarding release of health information from Alameda County Substance Use Services, please call 1 (510) 567-8100.

Contact your SUD treating provider to pick up/deliver or mail/fax your completed release of information authorization forms.

Next Steps after requesting medical records

  • Please allow up to 15 calendar days for your request to be processed. If you indicated the option to pick-up your medical records, you will be contacted by the ACBH Custodian of Records Office or the treating clinician’s office when your records are ready. A government photo ID is required.
  • If an individual other than the patient is picking up the records, then that individual must have an original signed authorization letter from the patient and a government photo ID.
  • Once you have obtained and reviewed your records, if you find an error that requires correction, please discuss it with your provider or use the form provided below to request a correction/amendment. Please include a copy of the page(s) where the error(s) occur and the completed form. You will receive a written reply within 60-days but for more complex cases, this may be extended an additional 30 days.

ACBH & Substance Use Services understands that medical information about you and your health is personal. We are committed to protecting your medical information. This notice will tell you about the ways in which we may use and disclose medical information about you, please see our Notice of Privacy Practices.

Copyright © 2023

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