The Health Information Management Services (Medical Records) Department is located on the first floor of O’Connor Hospital, across from the Gift Shop.
Completing a Release of Information Form
Patients or their legal representatives can get copies of their medical records, or have copies sent to another facility. To do this, O’Connor Hospital requires a completed and signed Request for Release of Medical Record Information form before we can release the records to anyone, including the patient. This release of information form is available as a Spanish version and a Vietnamese version.
To Request a Copy of Your Medical Records or X-Ray and Radiology Images
- Print and complete the Request for Release of Medical Record Information form. (The form must be completed, dated and signed.)
- Make sure to specify which parts of your medical records you wish to obtain. Often the discharge summary, operative report and history and physical exam have information needed for continued care.
- Requests/authorizations for the following information must be initialed as indicated on the form by the authorized person:
o Psychiatric Care
o Alcohol/drug abuse
For information regarding release of medical record information, call (408) 947-4719; for information regarding radiology films or the CD library, call (408) 947-4730.
Submitting Your Request
Once you have completed your request for release of medical information, mail or bring in person to:
Health Information Management Department
Release of Information
2105 Forest Avenue
San Jose, CA 95128
Hours: Monday through Friday, 8 a.m. to 4:30 p.m.; closed on holidays and weekends.
(If the department is closed, there is a specific mailbox where you can drop off your request by the Medical Record Department door.)
Fax requests for the Release of Medical Record Information form to:
Attn.: Release of Information
Cost for Copy of Information
Records requested for a physician or other provider are sent to the provider at no cost. If you would like to obtain a copy for your records the following costs apply:
- $0.25 per page
- If your charges exceed $100, we may require payment before the records are released.
For X-Ray or radiology images, the first CD or set of films is free; additional copies cost $15 for CD, or $15 for each film. To contact the Radiology Film/CD Library, call (408) 947-4730.
- If you plan to have someone else pick up your records, make sure your representative has an original, signed authorization letter from you, as well as a photo ID.
- Please allow up to 10 business days or 14 calendar days for your request to be processed.
- If you indicate that you want to pick up your forms in person, you will be contacted by the Release of Information Office when your records are ready. A photo ID is required.
To Obtain a Copy of Your Birth Certificate
Copies of birth certificates can be obtained through the Clerk Recorder’s Office of Santa Clara County. For more information, please call 408-299-5688 or visit their website: www.clerkrecorder.org