Please read the information below in the “Important Information About Requesting Medical Records” section and ensure that all sections of the authorization are completed.
Please allow reasonable time to process your request. The legal maximum time to fulfill requests is 15 days, but we strive to process requests sooner than that. We will contact you if we experience delays or are unable to fulfill your request.
Locations and scope of request
Our hospitals are set up to accommodate requests for all Keck Medicine of USC locations. Should you wish to receive records for all locations, please direct your request to one of the hospitals. You also may submit a request directly to one of the USC Care clinics if you only need records from that location.
Important notice about completing authorization form
The HIPAA form is a document required by California and Federal law. It allows us to release records to your designated recipient, but it must be completed fully and accurately. Your request will be delayed if the below are not completed:
- Patient Information:
- Patient’s full name (list any and all names the patient may have used)
- Patient’s date of birth
- To whom the records will be released (name and full address)
- Purpose for which the information may be disclosed (e.g., continuity of care, legal matter, personal use)
- The specific health information being requested:
- Dates of service
- Type of reports/information
- Patient’s signature or legal representative’s signature
Authorizations signed by a personal representative (someone other than the patient) must be verified by including a copy of one of the following documents:
- Legal guardianship papers
- Advance Directive/Healthcare Power of Attorney, for patients unable to make healthcare decisions
- Designation of Personal Representative, which allows the representative to act on the patient’s behalf with regard to personal health information
Requests for medical records of deceased patients require a copy of the death certificate or evidence of next of kin or executorship of the estate. Records can be released to anyone whom the patient authorizes (in writing) to receive them. If the authorization’s expiration date is not noted, the authorization will be valid for 90 days.