Custodian of Records

• Authorization to Use and Disclose Protected Health Information (PHI)

• Health Insurance Portability and Accountability Act

• Access to Public Records

• Request for Public Records

• Requesting Immunization Records

• Publications available online

Format and accessibility information

About downloading files

Medical Records - Protected Health Information (PHI)

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.

Medical records are maintained according to retention guidelines.

HIPAA Downloads
Description	View
Authorization to Use and Disclose Protected Health Information (PHI) - This authorization form is used by County of Orange clients to request a copy of their medical information or to request that their medical information be released to another health care provider.
Revocation of Authorization to Use or Disclose Protected Health Information - This form is now required under HIPAA. If the client/patient wants to revoke an authorization, it must be done in writing and will be processed through Custodian of Records office.
	Instructions
Request for Special Restriction on the Use or Disclosure of PHI – This form is used by a County of Orange client to request restrictions on the release of their medical information.
Termination of Special Restriction – This form is to be completed by client or by HCA Program to communicate and document cancellation of restrictions on medical information.
Request for Restriction on the Manner/Method of Confidential Communications – This form is used by a County of Orange client 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 – This form is used by a County of Orange client to request an amendment to their medical information.
Request for an Accounting of Disclosures - This form is used by a County of Orange client to request an accounting of medical disclosures that the client might not otherwise be aware of, such as reporting a communicable disease.

For more information please visit the County of Orange HIPAA Web Site

Access to Public Records

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.

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Request for Public Records
Title	Description	View
Public Records Request	Statistics Studies Policies and procedures
Animal Care Services	Bite reports Impound reports Dog vs. Dog, Dog vs. Cat, Dog vs. Car, etc.
Environmental Health	Health inspections Plumbing problem complaint Food poisoning complaint Water quality Medical Waste
Hazardous Waste / Underground Tanks	Hazardous Waste Generators Underground Storage Tanks Solid Waste Proposition 65 reports Certified Unified Program Agency (CUPA)

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