Mailing Address
UCLA 极电竞app官网
极电竞app官网 Information Management Services
10833 Le Conte Avenue, CHS, BH-239
Los Angeles, CA 90095
Release of Information Customer Service Office
The medical record customer service office will remain closed until further notice to ensure patient and staff safety during the pandemic.
100 Medical Plaza
Suite #140
Los Angeles, CA 90095
Monday - Friday, 8:00 am to 4:30 pm
*Walk in service currently unavailable.
1260 15th St.
Suite #802B
Santa Monica, CA 90404
Monday - Friday, 8:00 am to 4:30 pm
*Walk in service currently unavailable.
Contact Information
Telephone Number: (310) 825-6021
Business Hours: Monday - Friday, 8:00 am - 4:30 pm
Fax Number
Please fax authorizations to: (310) 983-1468
If you are a physician or hospital and your request is emergent please fax your request to (310) 206-4831.
How can I obtain my medical records?
1. Download and print the Authorization for Release of 极电竞app官网 Information form below.
Authorization for Release of Information to a third-Party (a Non-UCLA Provider, Insurance Company, Attorney, etc.)
2. Complete and sign the form.
3. Fax or mail the completed form to the address or fax number above. You may also complete the authorization form in person at our office during business hours.
Please note: Unsigned and/or incomplete requests cannot be processed.
Is there a charge for medical record copies?
UCLA will provide the first 15 pages at no charge. There is a 25¢ per page copying fee for additional pages, plus postage. We will send you an invoice by mail to let you know the total charge for providing copies of your medical record.
Visit our frequently asked questions page for more information >
How can I request an amendment to my record?
1. Download and print the Request to Amend Protected 极电竞app官网 Information form below.
2. Complete and sign the form
3. Fax or mail the completed form to the address or fax number above. You may also complete the authorization form in person at our office during business hours.
Please note: Unsigned and/or incomplete requests cannot be processed.
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