HCA / Custodian of Records P.O. Box 355 Santa Ana, CA 92702
Office of Custodian of Records 200 W. Santa Ana Blvd., Suite #125 Santa Ana, CA 92701 Please note that our public entrance is on Sycamore.
Hours of Operation:
Monday - Friday 8:00am - 5:00pm
New Years Day Memorial Day Veteran's Day Martin Luther King, Jr. Day Independence Day Thanksgiving Day & Lincoln's Birthday Labor Day Friday after Thanksgiving President's Day Columbus Day Christmas Day
Any time a patient is treated by the Health Care Agency, a medical record is made. Your medical record is protected under State and Federal confidentiality laws including HIPAA. The Custodian of Records office oversees all requests for medical records maintained by the Health Care Agency. For more information please visit the County of Orange HIPAA web site.
When you receive immunizations at a Health Care Agency clinic, you are given a copy of your "shot card" to keep. If you need to request an additional copy of your immunization information, you can return to the Immunization Clinic and request an additional copy and complete an authorization form at the clinic or complete the "Authorization to Use and Disclose Protected Health Information form on this page.
The Custodian of Records office oversees all requests for medical records maintained by the Health Care Agency. A copy of your medical record can be released to you or someone you identify in a signed patient authorization (a third party). Use the “Authorization to Use and Disclose Protected Health Information” form below to request a copy of your medical record, COMPLETE all required information and SIGN.
The following authorization form meets HIPAA regulations and can be used to request records. The usual turnaround time is 7-10 days to process the request for copies of medical records. Some fees may apply.
Medical Records Authorization
Authorization to Use and Disclose Protected Health Information (PHI) This authorization form is for: County of Orange clients to request a copy of their own medical information or to request that their medical information be released to another health care provider. Third parties such as client representatives or attorney’s requesting medical information.
Additional Forms regarding Medical Records
Revocation of Authorization to Use or Disclose Protected Health Information - Instructions available in Word or PDF format.
Request for Special Restriction on the Use or Disclosure of PHI - to request restrictions on the release of their medical information.
Termination of Special Restriction - to communicate and document cancellation of restrictions on medical.
Request for Restriction on the Manner/Method of Confidential Communications – to request special arrangements for communication of their medical information, such as using a cell phone or work phone instead of a home phone.
Request to Amend PHI - to request an amendment to their medical information.
Request for an Accounting of Disclosures - to request an accounting of medical disclosures that the client might not otherwise be aware of, such as reporting a communicable disease.
Frequently the Health Care Agency receives requests from the public and members of the media to access public records. The California Public Records Act requires public agencies to provide access to its records. These requests may ask for information maintained by the Agency in regards to inspections and investigations pertaining to Agency evaluations or regulations, for statistical data, for policies, for reports, etc. Certain information, such as names of complainants, personal medical information, trade secrets persons or firms engaged in ongoing litigation, will not be released to the public as directed by the California Public Records Act and the California Confidentiality of Medical Information Act.
All requests for public records are handled through the Custodian of Record office. Please specify the name and address of the facility when completing the form.
Making Orange County a safe, healthy, and fulfilling place to live, work, and play, today and for generations to come, by providing outstanding, cost-effective regional public services.
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