Request Medical Records (HIM)
To request medical records:
A. Download, Print, and Complete an Authorization Form
For requestors who need to have their medical records from our hospital released to an outside entity:
- Download Form - English
- Download Form - Spanish
- Release of Information FAQs - English
- Release of Information FAQs - Spanish
Once you have completely filled out the form, please include a copy of the requestor's valid identification (any government-issued ID such as a passport or driver’s license).
Please note: If patient is over 18 at the time of the request, the patient must authorize release of their medical records and include a valid copy of their identification, including signature (unless they are physically unable to do so).
Disclaimer: In accordance with California State Law Children’s Hospital Los Angeles cannot process authorizations for release of medical records signed electronically. To avoid delays in receiving records, please print and sign the authorization. Upon completion please submit the form and a copy of a government issued identification to the address, fax or email found on the authorization.
B. Submit the Authorization Form
Please submit the Authorization Form along with a copy of identification through one of the following methods:
Via e-mail: email@example.com
Children's Hospital Los Angeles
Attn: Medical Records, Release of Information
4650 Sunset Blvd MS #46
Los Angeles, CA 90027 Follow-up:
To follow up on your request:
Call 323-361-2387 between 8 a.m. - 4:30 p.m.
The cost for requested records is dependent upon the purpose of the request:
- Personal: No cost, but please note that any record request that results in over 40 pages (regardless of medium requested) will be put on a CD
- Outside Medical (released directly to outside physician or outside facility): No cost
- Others, including attorneys or copy services: Contact the "Release of Information" Department directly at 323-361-2387 between 8:00 a.m. - 4:30 p.m. for further details
D. Phone Inquiries
For questions or more information, you may call 323-361-2387 during regular business hours. You will be prompted to select English or Spanish as your language of choice, and then be provided with the following options for more information:
- Press 1 to obtain information about how to obtain copies of a patient's medical record
- Press 2 to discuss a bill
- Press 3 to be transferred to the X-ray or Radiology Department
- Press 4 for other inquiries or to check status of a medical records request
- If none of the selections above accommodate your needs, you may remain on the phone for a representative to assist you
E. Change in Name / Change in Demographics
If you need to change a patient’s name or demographic information, the patient or guardian must use the following form. Please fill out this form, sign and date the form, and provide the legal documentation supporting the requested changes. Please email the form and legal documentation to firstname.lastname@example.org. Your request will be processed within 48 business hours. If you have any further questions, you may email email@example.com or call 323-361-2330.