Services
Medical Records Release
To maintain patient confidentiality and assure compliance with federal and state privacy laws, health information may not be released without a patient’s written authorization (except as permitted by law). The information below describes the process of requesting medical records that you may have at UC Davis Student Health Services (SHS). The steps involved depend on what records you want provided and/or for whom you want your records provided to.
In most cases, you will need to download and submit an Authorization For Release of Health Information Form (pdf). Signed and completed authorization forms may be submitted in person, by fax, or by mail:
| In Person | By Fax | By Mail |
|---|---|---|
| Drop off the form at the SHS Medical Records department located at Cowell Student Health Center | 530.752.5587 | Student Health Services ATTN: Medical Records University of California One Shields Avenue Davis, CA 95616-8711 |
Please note:
- Records involving HIV testing, mental health counseling or alcohol and drug abuse information can only be released with a specific request from you.
- Mental health notes must be reviewed by a mental health provider before being released.
- Records beyond 7 years of last visit may not be available.
Select the statement that matches your request:
- Medical Records to an Outside Provider or Facility
- Immunization Records for Yourself, or an Outside Provider or Facility
- Medical Records for Personal Use
- For More Information or Assistance Completing and Authorization Form
Medical Records to an Outside Provider or Facility
- Signed and completed Authorization Form (pdf) is required
- No fees charged to process request
- Up to 15 calendar days to process request
Immunization Records for Yourself, or an Outside Provider or Facility
This section applies if you are only requesting immunization records. If you are requesting more than immunization records, see information above for an outside provider/facility or below for personal use.
- Signed and completed Authorization Form (pdf) is required
- $5 fee charged to process request
- Up to 15 calendar days to process request after authorization form has been received
- Records can be mailed, faxed or picked up
Medical Records for Personal Use
Currently Registered Student:
- Signed and completed Authorization Form (pdf) is required
- $5.00 Processing fee plus an additional $0.15 per page copied
- All mailed records are sent via certified mail and carry an additional $4.00 fee
- Records are sent by certified mail unless the patient specifies that they want to pick them up. If patient chooses to pick up records, mailing fee does not apply.
- Fees are billed directly to your student account
- Up to 15 calendar days to process request
Former Student or Non-student:
- Signed and completed Authorization Form (pdf) is required
- $5.00 Processing fee plus an additional $0.15 per page copied
- All mailed records are sent via certified mail and carry an additional $4.00 fee
- Records are sent by certified mail unless the patient specifies that they want to pick them up. If patient chooses to pick up records, mailing fee does not apply.
- After we receive your completed authorization form, you will be notified of the total cost to prepare a copy of your records. Payment is accepted via check or money order made out to “UC Regents”
- Your request will be processed upon receipt of payment
- Up to 15 calendar days to process request upon receipt of payment
For More Information or Assistance
If you have questions or need help with your release request you can visit the SHS Medical Records department located at the Cowell Student Health Center or call 530.752.2300 and select option #4.
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