Additional Forms Regarding Medical Records
Revocation of Authorization to Use or Disclose Protected Health Information - Word Revocation of Authorization to Use or Disclose Protected Health Information - PDF |
| Request for Special Restriction on the Use or Disclosure of PHI - to request restrictions on the release of their medical information. |
| Termination of Special Restriction - to communicate and document cancellation of restrictions on medical. |
| Request for Restriction on the Manner/Method of Confidential Communications – to request special arrangements for communication of their medical information, such as using a cell phone or work phone instead of a home phone. |
| Request to Amend PHI - to request an amendment to their medical information. |
| Request for an Accounting of Disclosures - to request an accounting of medical disclosures that the client might not otherwise be aware of, such as reporting a communicable disease. |
Access to Public Records
The California Public Records Act requires public agencies to provide access to public records held by Health Care Agency (HCA). Requests may be made for records regarding inspections, investigations, evaluations, statistical data, policies, reports, etc. Certain information, such as names of complainants, personal medical information, and records regarding ongoing litigation will not be released pursuant to the California Public Records Act and various privacy rules.
Requests for HCA public records, including those maintained by Environmental Health, can be made by clicking on the links below. To assist you in locating your records please provide as much information as possible about the request including business name and address if applicable.
| Records Request | ||
|---|---|---|
| Title | Example of Records | View |
| Environmental Health |
| Click here for Environmental Health records request |
| Hazardous Waste/Underground Tanks |
| Click here for Hazardous records request |
| All Other Health Care Agency Records |
| Click here for all other HCA records |
Subpoenas for Health Care Agency (HCA) Records
Subpoenas for HCA records or court appearances must be personally served. The release of records or disclosure of client information will be subject to existing federal, state, and county regulations. Each subpoena will be evaluated according to the type of request, the program or service provided to the client, and whether or not the records are confidential, in which case they will not be released.
Fees for Production of Subpoenaed Records
The production of records pursuant to a subpoena requires an advance minimum payment of $15.00, however, a reasonable cost may also apply, such as: payment of fifteen cents ($0.15) per page for photocopying; twenty cents ($0.20) per page for copying from microfilm; actual postage; clerical costs for locating and making records available not to exceed twenty-four dollars ($24) per hour, calculated to the nearest quarter hour, or any actual costs charged by any third person for retrieval/return of records.
Court Appearance
An advance deposit fee of $275 per day is required at the time of service of a civil subpoena for appearance at a trial or hearing. A demand for payment for the full amount will be billed to the requesting party after the testimony is complete.
Links in this section relate to Body