United States Department of Veterans Affairs

VA Long Beach Healthcare System

Release of Information

Our Release of Information staff will be happy to assist you with requests for your medical records. We also assist providers with completing forms for patients.

We can assist you with the following:

  • Access to your medical records
  • Obtaining copies of your medical records
  • Requests to amend your medical records
  • Completion of forms for benefits, insurance, and other reasons

The Release of Information Staff is expert in our patients' rights and their medical records.

The Release of Information Office is located in the Building 126OP, basement, room OP-01.

How to Request Information

All requests for medical records must be in writing.  To request a medical record, please use one of the forms listed in the column to the right, complete the requested information, sign the form, and mail it to the following address —

VA Long Beach Healthcare System
Release of Information (HIMS)
5901 E 7th street
Long Beach, CA 90822

Because forms must contain an original signature, e-mailed forms cannot be accepted but faxed forms can be accepted.  Fax:  562-826-5599.

Requests for records will take approximately 10-14 days to process. Release of Information staff may be contacted at:  562-826-8000, 3344

 

Fees

There is no cost to send copies directly to another health care provider. If copies are for a patient's personal use, photocopying fees may be assessed.


Patient Information

Patient Information
Eligibility
Make, Change, or Cancel an Appointment 
Advance Directives 
Patient Education
Customer Service 
Discharge
Billing and Insurance 
Release of Information 

Release of Information Forms

pdf document Request for and Authorization to Release Medical Records or Health Information (VA 10-5345) 
pdf document Individuals' Request for a Copy of Their Own Health Information (VA 10-5345a) 

Related Links

Notice of Privacy Practices