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   Health Information Management
   Release of Information
   1555 Soquel Dr.
   Santa Cruz, CA 95065
   P: 831-462-7718
   F: 831-462-7628 

   Patient Accounting
   P: 831-457-7001
Diagnostic Imaging
Radiology
1555 Soquel Dr.
Santa Cruz, CA 95065
P: 831-462-7365 


 

 

 

 

 


    —Patient’s Request for Access to Protected Health Information    (Spanish)

    —Authorization for Use or Disclosure of Protected Health Information    (Spanish)

    —Radiology CD/Film




Q-01: Where is your Release of Information Department?

Q-02: What are your business hours?

Q-03: How can I get a copy of my medical records?

Q-04: I would like to request my records. Should I just request the entire chart?

Q-05: I’m still in the Hospital. May I request my records?

Q-06: Can I fax or electronically submit the request for release of information?

Q-07: How long does it take to receive health information?

Q-08: Will I need to present a form of identification?

Q-09: Can someone act on the patient’s behalf?

Q-10: Can you give me my medical information over the phone?

Q-11: Does the Release of Information department handle all medical information releases?

Q-12: Do you accept faxed authorization from other facilities?

Q-13: Why do I have to sign an authorization to obtain 'my information'?

Q-14: Do I have to pay for copies of my medical information?

Q-15: Does my family physician get copies of my medical records?

Q-16: Can a parent or legal guardian sign a release for records for a patient that is 18 years old?

Q-17: Can a parent or legal guardian sign a release for record for a patient that is under 18 years old?

Q-18: Can you fax my medical information?

Q-19: Can my spouse get my medical records without my authorization?

Q-20: I am divorced. Can my ex-spouse request my medical information?

Q-21: Can my spouse or representative pick up my medical records?

Q-22: How do I get a copy of my birth certificate?

Q-23: How can I get a correction to an error on a birth certificate?

Q-24: How can I get a copy of a death certificate?

Q-25: How can I get the medical records of a deceased relative?

Q-26: I need a list of my treatment dates for my insurance company. Can I get them?

Q-27: I am calling from an insurance company and need to confirm the discharge date of a patient recently in the hospital. Can you verify the discharge date for me over the phone?

Q-28: I am from a physician’s office and I need copies of reports for our files and/or for billing. How do I get them?


Q-01: Where is your Release of Information Department?

We are located in the Medical Records department on the ground floor of Dominican Hospital. Enter through the admission doorway (on the right side of the main entrance) and take the first elevator on the right hand side down to the ground floor. Take a right out of the elevator and walk down to the end of the hallway.  


Q-02: What are your business hours?

Health Information Management is open Monday through Friday 7:00 a.m. to 5:00 p.m. We are closed on weekends and holidays to the general public.   


Q-03: How can I get a copy of my medical records?

Download and complete the form “Patient’s Request for Access to Protected Health Information,” in order to start the process of receiving a copy of your medical records. This form is available by clicking the link on this page or by visiting our office. Fax, mail, or walk-in the completed authorization form to one of the appropriate locations listed above.

To avoid delays in your request, please make sure you completely fill out all fields. We process regular requests in the order they were received but we do triage record requests putting the most time-sensitive and care-oriented requests first.   


Q-04: I would like to request my records. Should I just request the entire chart? 

Likely not necessary. You may request your entire chart and we will review and release all documentation for you. It is likely that you will not need that much information about your visit. For this reason we offer the option to receive a “pertinent package.” This package includes all of the necessary information, including your history and physical, discharge summary, consultations, test results, etc. Instead of checking the entire record box you have the option to ask for specific information. You are welcome to call and speak with one of our specialists for more information.


Q-05: I’m still in the Hospital. May I request my records? 

You may. However, please be aware that federal and state requirements allow time for your treating physician to document. This can take between twenty-four (24) hours and fourteen (14) days after discharge. We will release the data that we have but it may not be a complete record set. If you are interested in a particular piece of documentation you may call and ask if that particular piece has been completed and is obtainable in your chart. The more time you allow between your discharge and your request the more apt you are to receive a complete record set.

For your information: If you are being transferred to a different facility, it is customary for a summary of your stay at Dominican Hospital to be sent with you or via fax upon discharge; this document is commonly referred to as a transfer summary or discharge summary. If you wish to obtain a copy of this record, please wait until after you have been discharged from the hospital or ask your care provider if any documentation is being sent ahead of time.


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Dominican Hospital
1555 Soquel Dr
Santa Cruz, CA 95065
(831) 462-7700