Authorization to Release Forms
- Release of information form in English/Spanish
Mon - Fri
- Phone: (562) 997-2002
Health Information Management
Health Information Management (Medical Records) is committed to providing the highest quality of service to our patients, physicians, staff and other healthcare information users by ensuring the accurate, dependable and secure collection, maintenance and appropriate dissemination of information.
Now with our state of the art EMR (Electronic Medical Record) you can rest assured that your private health information is kept securely. Our goal is to make sure your private information stays private.
Medical Records Questions
To obtain a copy of your record please follow below steps.
- Print and complete College Medical Center Authorization From (In English/Spanish in the top of the page)
- Attach a copy of a valid picture ID card such as (Driver License, State ID card, or passport)
- Fax your request to (562) 997-2002
- E-mail your request to email@example.com
* Please be sure to complete the form in its entirety and sign. An incomplete or unsigned Authorization Form cannot be processed.
You will be contacted once we receive the request to inform you of the possible charges. The request will not be processed until the payment is received (please see below for the acceptable payments method). The charges are as follow but not limited to;
- 10 cents per page (paper).
- $15 flat rate for a copy of your entire record(s) on CD.
- $15 flat rate for x-ray film on CD
- For records currently in storage (Pacific Hospital of Long Beach) there is extra $35 retrieval fee aside from the cost mentioned in #1 and #2.
- $15 flat rate if you request your records to be mailed.
Payment Methods: You can mail or bring a money order made out to “College Medical Center”. We also accept cash, but unable to accept credit card or ATM payments.
Correspondence may be reached at: (562) 997-2002.
NOTE: A relative, spouse, or friend cannot request a copy or pick up your medical records unless there is a power of attorney over you for your healthcare decision making. You can submit the authorization form with a copy of your valid picture ID allowing someone else to pick up your records. The authorized individual must provide us with a valid picture ID at the time of pick up.
Behavioral Health records are released only upon the professional judgement of the psychiatrist who cared for you during your stay at CMC. You may be denied access to these records if Psychiatrist believe in their professional judgment the information contained in your medical record may be detrimental to you.
College Medical Center medical records are kept for a maximum of 10 years for adults, and 1 year after maturity age of a minor. For mother and her newborn records are kept 19 years.
Birth Certificate Questions
To get a copy of your newborn birth certificate prior to February 1, 2016 please contact Los Angeles County Recorder, Attention: Birth Certificates, 12400 E. Imperial Highway, Room 1002, Norwalk, CA 90650. You may call (800) 201-8999 or visit the Los Angeles County Recorders Web Site for more information.
Death Certificate Questions
The hospital does not issue Death Certificates.
To get a copy of your beloved one’s Death certificate please contact Los Angeles County Recorder, Attention: Death Certificate, 12400 E. Imperial Highway, Room 1002, Norwalk, CA 90650. You may call (800) 201-8999 or visit the Los Angeles County Recorder’s Web Site for more information.