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Medical Record Release of Information Department

release
Mailing Address:
1300 Crane Street
Menlo Park, CA 94025-4283
Contact Phone: (650) 498-6166
Fax: (650) 324-9447
Days and Hours:
Monday - Friday
8:30 am - 12:30 pm,
1:30 pm - 5:30 pm

 

MyHealth Proxy Access for Parents Now Available!

MyHealth Proxy Access for parents and guardians is a convenient, efficient way for you to stay on top of your minor child's medical care. Once you've registered for MyHealth's Proxy Access, you will have a range of online options, including the ability to view your child's upcoming appointment schedule, lab results, radiology results, immunization records, and send non-urgent messages directly to your pediatrician's office. Learn more
 

Requesting Medical Records

Patients, or their legal representative, may inspect or obtain copies of their Menlo Medical Clinic (MMC) medical records or have copies sent to another medical facility.

Before MMC allows inspection or provides a copy of a patient's records to anyone (including the patient or their representative), Menlo Medical Clinic is required under the State of California's Confidentiality of Medical Information Act to obtain an original, complete and properly executed Authorization for Disclosure of Health Information. Please print and complete the release form in English or Spanish:

Once you have fully completed the form, you have three ways to get the completed form back to us.

  1. In Person. Bring the form to: Medical Records Department

    Release of Information Desk
    1300 Crane Street, 3rd Floor
    Menlo Park, CA 94025

  2. By Mail. Please mail to the above address.
  3. By Fax. Please fax to (650) 324-9447.

    Please allow 10 working days, excluding holidays for processing.

Requesting Radiology Images

Patients, or their legal representative, may inspect or obtain original or copies of their imaging studies performed at Menlo Medical Clinic (MMC) or have them sent to another medical facility.

Before MMC allows inspection or provides a copy of a patient's records to anyone (including the patient or their representative), Menlo Medical Clinic is required under the State of California's Confidentiality of Medical Information Act to obtain an original, complete and properly executed Authorization for Disclosure of Health Information. Please print and complete the release form in English or Spanish:

Once you have fully completed the form, you have three ways to get the completed form back to us.

  1. In Person. Bring the form to:
        MMC Radiology Department
        1300 Crane Street, 1st Floor 
        Menlo Park, CA 94025
  2. By Mail. Please mail to the above address.
  3. By Fax. Please fax to (650) 329-0586.

    Please allow 3 working days, excluding holidays for processing.

Frequently Asked Questions

  • If someone is to act on the patient's behalf, a Legal document such as Medical Power of Attorney, Executor of an Estate, Conservator, Legal Guardian, etc. to act on the patient's behalf are to be presented and a copy is to be placed in that patient's chart as part of the legal medical record.
  • Authorizing individual to pick up copies of your records must be done. Complete the area on the form authorizing someone to pick up your copies. Photo ID must be shown by yourself or an authorized person before we will release copies of your records.
  • California Law allows up to 15 consecutive days (10 working days, exclude holidays) from the date the request is received for MMC to copy your records. Please plan your request accordingly. MMC will do everything possible to meet your needs. If you have checked that you wish to pick up your records, please wait for an MMC representative to call you that they are ready.
  • Hours: the ROI desk is open: Monday- Friday (except holidays) from 8:30am-12:30pm; 1:30pm-5:30pm; Office is closed 12:30pm-1:30pm for lunch.
  • MMC DOES NOT FAX OR E-MAIL copies of patient's records unless it is a medical emergency.
  • Copies To Be Sent To Another Facility: At times, records have been misplaced when delivered by mail. Please check with the Medical Records Department of the other facility before contacting our ROI desk. If they are not found, please do not hesitate to contact us at 650-498-6166.
  • Outside Provider/Facility is being requested to send copies to MMC, you may use our form. Please mail or drop the completed form off at the other facility for processing.
  • Avoid delay. Be sure to complete the request in full.
  • Copy Charges:
    • Patient Access: $25 on CD; if requested hard copy/paper copies over 20 pages $0.25 per page.
    • Continued Care: No charge when referred to another provider/facility by a MMC/UHA Provider
    • Method of Payment: Medical Records Release of Information accepts checks in the amount only and credit cards.