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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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Information Release Authorization

A parent, client, or their legal representative may inspect and/or obtain a copy of their medical records or have copies of medical records sent to another facility.

Children's Health Council requires a completed and signed Authorization for Release of Health Information Form before releasing any documents to anyone, including the client. In some instances, a client's physician, psychologist, or social worker may also be required to approve a request made using a release form.

Under the HIPAA privacy rule, a parent no longer has the right to access their child’s medical information once their child has turned 18 (and is now a legal adult). In this situation, an Authorization for Release of Health Information form will be required to allow us to communicate or release information to the parents.

Request Your Records

1


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)

2


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

3


Send your completed form(s) by mail, email or fax:

CHC Medical Records
650 Clark Way
Palo Alto, CA 94304

Fax: 650-688-3636

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?

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.

For questions regarding your billing records, please contact the CHC Business Office:

Phone: 408.516.4171

Email: accounts@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.

HIPAA Privacy Notice