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Request Your Medical Records

Medical Records

Release of Information

A patient, 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. Washington Hospital Healthcare System requires a completed and signed Authorization for Use or Disclosure of Health Information form before releasing any documents to anyone, including the patient.

How to Request a copy of your medical records:

  • Print and complete the Authorization for Use or Disclosure of Health Information form
  • The release form must be completed, dated and signed
  • Please be sure to include the date(s) of service requested
  • We ask that you specify what components of your medical records you wish to obtain/release. Often, the Discharge Summary, Operative Report and History & Physical contain relevant information to suit your needs.
  • If you request your complete medical record, there will be a charge of 25 cents/page. There is also a processing time of up to 15 days for a copy of the complete medical record.
  • Requests must specify requesting/authorizing the following information:
    • Mental Health Treatment Information
    • HIV Test Results
    • Alcohol/Drug Treatment Information

If you have any questions regarding release of information, please call 510.818.6629.

You may deliver your forms via email or by mail. A photo ID is also required, so please be sure to include a color copy of your photo ID with any request.

Please mail to:
Washington Hospital Healthcare System
Attn: Health Information Management Department (HIM)
2000 Mowry Ave.
Fremont, CA 94538

Or email: Email:

For telephone support, call call 510.818.6629, Monday thru Friday, 8 a.m. to 4:30 p.m. (closed on holidays)