When you receive immunizations at a Health Care Agency clinic, you are given a copy of your "shot card" to keep. If you need to request an additional copy of your immunization information, there are two options:

1. Return to the Immunization Clinic and request an additional copy. You can complete an authorization form at the clinic and the clinic will provide the information to you at that time.
    
2. Download the authorization form from our Web site at ochealthinfo.com/custrecords.htm#Downloads. The form is titled "Authorization to Use and Disclose Protected Health Information."

Once the form is completed and signed, return to our office by fax or mail at:

511 N. Sycamore
Santa Ana, Ca 92701

fax: (714) 835-9312
Our phone number is: (714) 834-3536

Once we receive the request, it is processed and the immunization record is sent to you for a nominal fee of $.10 per page plus a charge for clerical time of $4.00 for 15 minutes (following the approved fee schedule for the County.) It usually takes about 7-10 days to receive the information, although it may sometimes take longer due to an increased number of requests.