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How to Inspect or Request a Copy of Your Medical Record
Patients, or their personal representative, may inspect or obtain copies of their Lucile Packard Children's Hospital medical records or have copies sent to another medical facility by following these instructions:
- Lucile Packard Children's Hospital is required under the State of California's Confidentiality of Medical Information Act to obtain an original, complete and properly executed Authorization for Release of Health Information form - English version / Spanish version - before we may allow inspection or provide a copy of a patient's records to anyone, including the patient or their representative. In certain cases a patient's physician, psychologist or social worker may also be required to approve a request.
- To inspect or request a copy of your or your child's records, please print and complete the Authorization for Release of Health Information form - English version / Spanish version. In completing the authorization form, please indicate the dates of treatment for which you are requesting information. This is particularly important for patients that have had multiple episodes of care at Lucile Packard Children's Hospital. You will also need to indicate the type of records you need and must specifically initial requests for information regarding AIDS/HIV, Psychiatric Care, or Alcohol/Drug Abuse.
- While many parents request their child's entire medical record, our experience has shown that the summary information in documents such as Discharge Summaries, Operative Reports, and History & Physicals contain the information that most people are seeking. If you are not sure what information you need from your records, please give us a call at (650) 497-8079 or drop by our office. Also, if you are requesting Radiology Images, Telemetry Tapes or Photos, they are not part of your medical record (i.e., your official records contain the reports that interpret those images, tapes and photos). You will need to contact the service that collected the data to receive a copy. The Radiology Film Library phone number is (650) 497-8578.
- Your or your child's medical records do not contain Billing Statements, our Patient Financial Services department maintains that information. The Financial and Insurance Information section of this web site contains instructions on how to obtain billing data.
Once the Authorization for Release of Health Information - English version / Spanish version - has been completed, you have three options for submitting it to Medical Records:
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Bring the form to:
Medical Records Department
Release of Information Office, Room 0252
Ground Floor
Hours: Monday - Friday, 8:00 am-4:00 pm, except Holidays
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Mail the form to:
Lucile Packard Children's Hospital
725 Welch Road
Palo Alto, CA 94304-5654
Attn: Medical Records, Release of Information
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Fax the form to:
(650) 497-8812
You may only inspect records within the Medical Records Department at the Hospital and there may be a retrieval charge. There may be a reproduction charge for creating a copy of your records. Call the Release of Information Office at (650) 497-8079 for information of fee schedules. If the medical record is being mailed to you, then you will also be charged for mailing costs. If the reproduction charges are greater than $100, then pre-payment will be required before your records can be mailed. All fees will be waived if you are requesting your records be sent directly to another medical facility or office.
Please allow 5 to 15 working days for your request to be processed. You will be contacted by the Release of Information Office when your records are ready for inspection, pick-up, or mailing. When you come to the Release of Information Office to inspect or pickup your request, please bring a photo ID. If an individual other than the requestor is inspecting or picking up the records, then that individual will need an original signed authorization letter from the requestor and a photo ID.
Lucile Packard Children's Hospital is located in Palo Alto, adjacent to Stanford University Hospital, approximately 20 miles north of San Jose, CA and 40 miles south of San Francisco.
Lucile Packard Children's Hospital
725 Welch Road
Palo Alto, California 94304
(650) 497-8000
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