How to Inspect or Request a Copy of Your Medical Record
Patients, or their personal representative, may inspect or obtain copies of their Ukiah Valley Medical Center medical records or have copies sent to another medical facility by following these instructions:
Ukiah Valley Medical Center is required under the State of California's Confidentiality of Medical Information Act to obtain an original, complete and properly executed Authorization for Release of Health Information form - English version / Spanish version - before we may allow inspection or provide a copy of a patient's records to anyone, including the patient or their representative. In certain cases a patient's physician, psychologist or social worker may also be required to approve a request.
To inspect or request a copy of your or your child's records, please print and complete the Authorization for Release of Health Information form - English version / Spanish version. In completing the authorization form, please indicate the dates of treatment for which you are requesting information. This is particularly important for patients that have had multiple episodes of care at Ukiah Valley Medical Center. You will also need to indicate the type of records you need and must specifically initial requests for information regarding AIDS/HIV, Psychiatric Care, or Alcohol/Drug Abuse.
While many parents request their child's entire medical record, our experience has shown that the summary information in documents such as Discharge Summaries, Operative Reports, and History & Physicals contain the information that most people are seeking. If you are not sure what information you need from your records, please give us a call at 707.463.7353 or drop by our office. Also, if you are requesting Radiology Images, they are not part of your medical record (i.e., your official records contain the reports that interpret those images). You will need to contact the service that collected the data to receive a copy. The Radiology Department phone number is 707.463.7342.
Your or your child's medical records do not contain billing statements; our Patient Financial Services department maintains that information. Questions or request for billing statement can be answered by calling 707.463.7670.
Once the Authorization for Release of Health Information - English version / Spanish version - has been completed, you have two options for submitting it to Medical Records:
Bring the form to:
Medical Records Department
Located next to the Gift Shop
Hours: Monday - Friday, 8:30 am - 4:30 pm, except Holidays
Mail the form to:
Ukiah Valley Medical Center
275 Hospital Drive
Ukiah, CA 95482
Attn: Medical Records, Release of Information
You may only inspect records within the Medical Records Department at the Hospital and there may be a retrieval charge. Hard copy request for complete records are handled by an outside company and you will be billed by the company before the records will be released. Call the Release of Information Office at 707.463.7353 for information of reproduction cost and mailing fees. All fees will be waived if you are requesting your records be sent directly to another medical facility or physician office.
Please allow up to 15 working days for your request to be processed. You will be contacted by the Release of Information Office when your records are ready for inspection, pick-up, or mailing. When you come to the Release of Information Office to inspect or pickup your request, please bring a photo ID. If an individual other than the requestor is inspecting or picking up the records, then that individual will need an original signed authorization letter.