How to request a copy of my medical, dental, behavioral health, and billing records?
- Please complete the online Release of Information (ROI) Form.
- Upload a digital copy of your Identification Card (e.g. driver’s license).
How long does it take to fulfill my request?
Requests are processed within 15-days after submission.
How will I receive my medical record?
On your application, you can select to receive your medical records by MyChart, secure e-mail, mail, fax (less than 50 pages), or pick up in person at our Beverly location. To maintain patient privacy we require picture identification before releasing your medical record copies.
If you are picking up your records in person, please call (323) 330-1635 before arriving to ensure documents are ready.
8405 Beverly Blvd
Los Angeles, CA 90048
Pick up hours are:
- Monday – Thursday 8:00 am and 4:00 pm.
- No pick-ups on Friday’s.
What is the status of my request?
For status please use one of the following contact options:
How do I request a copy on behalf of a patient?
If you are a physician, hospital, or third-party requestor, please fax your request to (323) 685-4052.
I found an error in my Medical Record, how do I request an amendment?
Please print and complete a Request for Amendment of Protected Health Information (“PHI”) form and submit it to BeverlyMedicalRecords@sabancommunityclinic.org or to the Front Desk at any one of our four locations.
Download Request Form: English | Spanish
How long will it take to get a decision about my Request for Amendment of Protected Health Information?
The Clinic will have 60 days to provide a written response to approve or deny the request.