Medical Records
Your CHC Health Information Team is here to make sure your health data is just as well cared
for as you are. Protecting your privacy is our top priority.
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Medical Records Access and Release
At Childrens Health Council (CHC), we uphold the confidentiality and privacy of our clients’ medical records while ensuring access to their information in a secure and compliant manner. Whether you are a parent, client, or legal representative, you have the right to review, obtain copies of medical records, or authorize the transfer of medical records to another facility.
Request Your Records
For Personal Access or Copies
Parents and Legal Guardians: To access or receive copies of your child’s medical records, please complete the Medical Records Request Form. This form enables you to directly request and receive the necessary medical records.
Adult Clients (18 and older): Adult clients can directly request their medical records using the Medical Records Request Form for their personal use or review. This form allows you to access your complete medical history and treatment records maintained by CHC. Whether you need your records for personal reference, review, or to share with other healthcare providers.
Medical Records Request Form (English)
Medical Records Request Form (Spanish)
To Authorize Release to Third Parties
Release to a Third Party: If you wish to have medical records sent to another individual or organization (such as another healthcare provider, school, or legal representative), you must fill out the Authorization for Release of Health Information Form.
Adult Clients (18 and older): Complete the Authorization for Release of Health Information Form to grant CHC permission to disclose your medical records to designated individuals or organizations, including Parents, healthcare providers, schools, or legal representatives.
Authorization of Use and Disclosure Form (English)
Authorization of Use and Disclosure Form (Spanish)
Next Steps after Requesting Your Records
Please allow up to 14 days for your request to be processed. If you indicated the option to pick up your medical records, we will contact you when your records are ready. A photo ID is required. If an individual other than the parent or client is picking up the records, they must have an original signed authorization letter from the client and a photo ID.
Once you have reviewed your records, if you find an error that requires correction, please discuss it with your clinician and review our Notice of Privacy Policy.
If you have any questions regarding a request for releases of Medical Records, please contact us.
Questions about your records?
CHC Medical Records
For questions regarding your medical records, please contact the CHC Medical Records Office:
Phone: 650.688.3614
Fax: 650.688.3636
Email: medicalrecords@chconline.org
Voicemail Instructions: Please leave your name, child’s name, and child’s date of birth.
CHC Billing Records
For questions regarding your billing records, please contact the CHC Business Office:
Phone: 408.516.4171
Email: billing@chconline.org
HIPAA & Your Privacy
CHC takes your privacy very seriously and follows all HIPAA regulations. If you have any questions about how we protect, secure and manage your health information, please contact our Chief Compliance Officer at privacy@chconline.org or 650.688.3612.
Get Started
Download the CHC Authorization for Release of Health Information Form using the links below.
CHC Authorization for Release of Health Information Form (English)
CHC Authorization for Release of Health Information Form (Spanish)
Complete Your Form
Specify which parts of your records you wish to obtain/release so we can quickly provide your documents. Fill out the PDF on your device, then print; or print the form and fill out by hand.
Don’t forget to:
- Date it
- Sign it
Send Your Form
Send your completed form(s) by mail, email or fax:
CHC Medical Records
650 Clark Way
Palo Alto, CA 94304
Fax: 650-688-3636
