Click On Link Below To Download Form

Request for Medical Records

All requests for release of medical information must be made by FAX or US MAIL. For your protection, email requests cannot be honored at this time.

To obtain your medical records:

  1. Download and print the Authorization for Release of Health Information Form.

  2. Please fill in all required information for processing of the Form.

  3. Please review the authorization where an individual check off is required. Make sure you have signed and dated the form for release of this information.

  4. Provide a copy of your current picture ID to verify your identity. 

Please note that requests that are not completed, signed and dated will be returned by mail for completion.

When the form is completed, you may fax or mail the request for medical records form to the Medical Records Department.

Mail request for medical records form to:

South Central Family Health Center 

4415 S. Central Avenue, Los Angeles, CA  90011

ATTENTION: Evelia Mora Renteria, Medical Records Lead

Fax:  (323) 908-4260       

Telephone (323) 908-4282

     

Find us Here

(323) 908-4200