Request a Medical Record

<!doctype html> <html xmlns="http://www.w3.org/1999/xhtml" lang="en"> <head> <title>Request a Medical Record</title> <meta name="description" content="John Muir Health is an integrated system of doctors, hospitals and other services providing the highest quality patient care every day through the contributions of our physicians, employees and volunteers. 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It is repeated here to avoid rendering with one style first and then switching to another. */ display: flex; justify-content: center; padding-bottom: 0.5em; padding-top: 0.5em; } /* style for dummy JmhSearch input UI and it has been added to load before the actual JmhSearch component */ .jmh-search-loadable { width: 14em; } .jmh-search-loadable.inactive { display: none; } .jmh-search-loadable-input { display: flex; } .jmh-search-loadable-input input[type=text]:not(.browser-default) { background-color: #fff; color: #666; padding: 0.5em; font-size: 1em; font-weight: 600; margin-bottom: 0; height: 1em; width: 10em; padding-right: 2.1em } .jmh-search-loadable-input input[type=text]:not(.browser-default)::placeholder { font-weight: 600; color: #B8B8B8;; } /* style for dummy Midpage JmhSearch input UI */ .midPageSearch .jmh-search-loadable { position: absolute; margin-top: 6em; padding-left: 12em; width: 100%; } .midPageSearch .jmh-search-loadable-input { width: 36em; } @media screen and 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transparent; } </style> <section class="headerMobileSearch jmh-search-component-section "> <div class='md jmh-search__parent'>  <div class='jmh-search-loadable'> <div class='jmh-search-loadable-input'> <input type='text' placeholder='Search' aria-label="search input"/> </div> </div> <jmh-search data-jmh-param='{"searchButtonText":"" ,"categoryTitleProviders":"Names" ,"categoryTitleSpecialties":"Specialists" ,"categoryTitleContent":"Pages" ,"maxHitsProviders":"3" ,"maxHitsSpecialties":"3" ,"maxHitsContent":"3" ,"minifiedView":"true" ,"initialSearchTermParamName":"JMH_searchTerm" ,"placeholderText":"Search" ,"locationPlaceholderText":"" ,"displayAcceptNewPatients":"" ,"acceptsNewPatients":"" ,"displayLocationBox":"" ,"instanceName":"headerMobileSearch"}'></jmh-search> </div> </section> </div> </div> </div>  <div class="JMHmobileLogin"> <div class="iconLogin" role="menu"> <a aria-label="login" role="menuitem" id="mobLogin" href="/patientportal" target="_blank"> <span> <svg class="icon"> 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tabindex="0" rel="noreferrer"> Cardiovascular Medical Group </a> </div> <div class="linkComponent parbase section"> <a href="/for-physicians/specialty-medical-group.html" class="linkComponent blue-grey-text text-darken-4 " target="_self" tabindex="0" rel="noreferrer"> Specialty Medical Group </a> </div> </div> </li> <li class="dropdown" role="menuitem"> <a aria-expanded="true" aria-haspopup="true" class="dropdown-toggle fsize-12" href="/giving.html" tabindex="0"> Giving </a> <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" class="plus" enable-background="new 0 0 256 256" version="1.1" viewBox="0 0 256 256" xml:space="preserve" tabindex="0"> <path d="M208,122h-74V48c0-3.534-2.466-6.4-6-6.4s-6,2.866-6,6.4v74H48c-3.534,0-6.4,2.466-6.4,6s2.866,6,6.4,6h74v74 c0,3.534,2.466,6.4,6,6.4s6-2.866,6-6.4v-74h74c3.534,0,6.4-2.466,6.4-6S211.534,122,208,122z"/> </svg> <svg style="display: none" xmlns="http://www.w3.org/2000/svg" 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Foundation </a> </div> <div class="linkComponent parbase section"> <a href="/giving/donor-impact.html" class="linkComponent blue-grey-text text-darken-4 " target="_self" tabindex="0" rel="noreferrer"> Donor Impact </a> </div> <div class="linkComponent parbase section"> <a href="/giving/gift-opportunities.html" class="linkComponent blue-grey-text text-darken-4 " target="_self" tabindex="0" rel="noreferrer"> Gift Opportunities </a> </div> <div class="linkComponent parbase section"> <a href="/giving/ways-to-give.html" class="linkComponent blue-grey-text text-darken-4 " target="_self" tabindex="0" rel="noreferrer"> Ways to Give </a> </div> <div class="linkComponent parbase section"> <a href="/giving/the-foundation/publications.html" class="linkComponent blue-grey-text text-darken-4 " target="_self" tabindex="0" rel="noreferrer"> Publications </a> </div> <div class="linkComponent parbase section"> <a href="/giving/the-foundation/publications.html#press-releases" class="linkComponent 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d="M208,122h-74V48c0-3.534-2.466-6.4-6-6.4s-6,2.866-6,6.4v74H48c-3.534,0-6.4,2.466-6.4,6s2.866,6,6.4,6h74v74 c0,3.534,2.466,6.4,6,6.4s6-2.866,6-6.4v-74h74c3.534,0,6.4-2.466,6.4-6S211.534,122,208,122z"/> </svg> <svg style="display: none" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" class="minus" enable-background="new 0 0 256 256" version="1.1" viewBox="0 0 256 256" xml:space="preserve" tabindex="0"> <path d="M208,134.4H48c-3.534,0-6.4-2.866-6.4-6.4s2.866-6.4,6.4-6.4h160c3.534,0,6.4,2.866,6.4,6.4S211.534,134.4,208,134.4z"/> </svg> <div class="submenu about"><div class="linkComponent parbase section"> <a href="/about-john-muir-health/annual-reports.html" class="linkComponent text-color-dark-grey " target="_self" tabindex="0" rel="noreferrer"> Annual Reports </a> </div> <div class="linkComponent parbase section"> <a href="/about-john-muir-health/awards-recognition.html" class="linkComponent text-color-dark-grey " target="_self" tabindex="0" rel="noreferrer"> Awards & Recognition </a> </div> <div class="linkComponent parbase section"> <a href="/about-john-muir-health/board-of-directors.html" class="linkComponent text-color-dark-grey " target="_self" tabindex="0" rel="noreferrer"> Board of Directors </a> </div> <div class="linkComponent parbase section"> <a href="/about-john-muir-health/community-commitment.html" class="linkComponent text-color-dark-grey " target="_self" tabindex="0" rel="noreferrer"> Community Commitment </a> </div> <div class="linkComponent parbase section"> <a href="/about-john-muir-health/employer-brokers.html" class="linkComponent text-color-dark-grey " target="_self" tabindex="0" rel="noreferrer"> Employers, Brokers, & Health Plans </a> </div> <div class="linkComponent parbase section"> <a href="/about-john-muir-health/executive-team.html" class="linkComponent text-color-dark-grey " target="_self" tabindex="0" rel="noreferrer"> Executive Team </a> </div> <div class="linkComponent parbase section"> <a href="https://www.givehealthjmh.org/" class="linkComponent text-color-dark-grey " target="_blank" tabindex="0" rel="noreferrer"> Make a Gift </a> </div> <div class="linkComponent parbase section"> <a href="/about-john-muir-health/mission-vision.html" class="linkComponent blue-grey-text text-darken-4 " target="_self" tabindex="0" rel="noreferrer"> Mission & Vision </a> </div> <div class="linkComponent parbase section"> <a href="/about-john-muir-health/our-partnerships.html" class="linkComponent text-color-dark-grey " target="_self" tabindex="0" rel="noreferrer"> Partnerships </a> </div> <div class="linkComponent parbase section"> <a href="/about-john-muir-health/press-room.html" class="linkComponent blue-grey-text text-darken-4 " target="_self" tabindex="0" rel="noreferrer"> Media Center </a> </div> </div> </li> </ul> </div> </div> <div class="aem-GridColumn aem-GridColumn--default--4 primarymenu-breaks-reg"> <div class="search_login u-coral-pullRight"> <div class="desktop-search" style="min-height: 37px"> <div class="jmhSearch parbase"><style> .headerDesktopSearch .jmh-search__field input[type=text]:not(.browser-default) { height: 1em; width: 10em; padding-right: 2.1em; } .headerDesktopSearch .react-autosuggest__suggestions-container--open { ; } .headerDesktopSearch .jmh-search__field { justify-content: center; } @media screen and (max-width: 600px) { .headerDesktopSearch .jmh-search__field input[type=text]:not(.browser-default) { width: 95%; } .mobile-search .jmh-search__field { align-items: end; flex-direction: inherit; } } .jmh-search__title { /* This is the same style as in the JmhSearch React component. It is repeated here to avoid rendering with one style first and then switching to another. */ display: flex; justify-content: center; padding-bottom: 0.5em; padding-top: 0.5em; } /* style for dummy JmhSearch input UI and it has been added to load before the actual JmhSearch component */ .jmh-search-loadable { width: 14em; } .jmh-search-loadable.inactive { display: none; } .jmh-search-loadable-input { display: flex; } .jmh-search-loadable-input input[type=text]:not(.browser-default) { background-color: #fff; color: #666; padding: 0.5em; font-size: 1em; font-weight: 600; margin-bottom: 0; height: 1em; width: 10em; padding-right: 2.1em } .jmh-search-loadable-input input[type=text]:not(.browser-default)::placeholder { font-weight: 600; color: #B8B8B8;; } /* style for dummy Midpage JmhSearch input UI */ .midPageSearch .jmh-search-loadable { position: absolute; margin-top: 6em; padding-left: 12em; width: 100%; } .midPageSearch .jmh-search-loadable-input { width: 36em; } @media screen and (max-width: 1199px) { .midPageSearch .jmh-search-loadable { padding-left: 10em; } .midPageSearch .jmh-search-loadable-input { width: 29em; } } @media screen and (max-width: 991px) { .midPageSearch .jmh-search-loadable { padding-left: 7.5em; } .midPageSearch .jmh-search-loadable-input { width: 22em; } } @media screen and (max-width: 775px) { .midPageSearch .jmh-search-loadable { padding-left: 16%; } .midPageSearch .jmh-search-loadable-input { width: 53%; } } @media screen and (max-width: 600px) { .midPageSearch .jmh-search-loadable { margin-top: 10em; padding-left: 8%; } .midPageSearch .jmh-search-loadable-input { width: 85%; } } .midPageSearch .jmh-search-loadable-input input[type=text]:not(.browser-default) { background-color: #fff ; color: #666 ; padding: 0.5em ; font-size: 1em ; font-weight: 600 ; margin-bottom: 0 ; height: 2em ; width: 100% ; border: none ; border-radius: 0 ; } .midPageSearch .jmh-search-loadable-input input[type=text]:not(.browser-default)::placeholder { color: transparent; } </style> <section class="headerDesktopSearch jmh-search-component-section "> <div class='md jmh-search__parent'>  <div class='jmh-search-loadable'> <div class='jmh-search-loadable-input'> <input type='text' placeholder='Search' aria-label="search input"/> </div> </div> <jmh-search data-jmh-param='{"searchButtonText":"" ,"categoryTitleProviders":"Names" ,"categoryTitleSpecialties":"Specialists" ,"categoryTitleContent":"Pages" ,"maxHitsProviders":"3" ,"maxHitsSpecialties":"3" ,"maxHitsContent":"3" ,"minifiedView":"true" ,"initialSearchTermParamName":"JMH_searchTerm" ,"placeholderText":"Search" ,"locationPlaceholderText":"" ,"displayAcceptNewPatients":"" ,"acceptsNewPatients":"" ,"displayLocationBox":"" ,"instanceName":"headerDesktopSearch"}'></jmh-search> </div> </section> </div> </div> <div class="auth" role="menu"> <a role="menuitem" id="dTlogin" href="/patientportal" target="_blank">MyChart Login</a> </div> </div> </div> </div> </div> </div> </section> </nav></div> <div class="inlineNavComponent parbase section"><nav class="inline-navigation " data-background-opacity=".9" aria-label="inline-navigation"> <link rel="stylesheet" href="/etc/clientlibs/jmh-components/inlineNavComponent.css" type="text/css"> <script src="/etc/clientlibs/jmh-components/inlineNavComponent.js"></script> <section class="jmh_header_secondary-menu white o90-md "> <div class="width-limit"> <div class="width-padding"> <div class="aem-Grid aem-Grid--12"> <div class="aem-GridColumn aem-GridColumn--default--12"> <ul class="secondaryMenu"> <li> <a href="/locations.html"> <div aria-hidden="true" class="sectionIcon"> <svg class="icon icon_map_outline"><use xlink:href="/etc/designs/jmh/clientlib-site/svg/sprites.svg#icon_map_outline"/></svg> </div> <div class="sectionName">Find a location</div> </a> </li> <li> <a href="/findadoctor.html"> <div aria-hidden="true" class="sectionIcon"> <svg class="icon icon_health"><use xlink:href="/etc/designs/jmh/clientlib-site/svg/sprites.svg#icon_health"/></svg> </div> <div class="sectionName">Find a doctor</div> </a> </li> <li> <a href="/billpay/"> <div aria-hidden="true" class="sectionIcon"> <svg class="icon icon_bill"><use xlink:href="/etc/designs/jmh/clientlib-site/svg/sprites.svg#icon_bill"/></svg> </div> <div class="sectionName">Pay a bill</div> </a> </li> <li> <a href="/get-involved/careers.html"> <div aria-hidden="true" class="sectionIcon"> <svg class="icon icon_job"><use xlink:href="/etc/designs/jmh/clientlib-site/svg/sprites.svg#icon_job"/></svg> </div> <div class="sectionName">Careers</div> </a> </li> </ul> </div> </div> </div> </div> </section> </nav> </div> </div> </div> </div> </div> </header> <div class="site-content"> <div class="banner"> <link rel="stylesheet" href="/etc/clientlibs/jmh-components/image.css" type="text/css"> <link rel="stylesheet" href="/etc/clientlibs/jmh-components/banner.css" type="text/css"> <script src="/etc/clientlibs/jmh-components/image.js"></script> <script src="/etc/clientlibs/jmh-components/banner.js"></script> <section class="banner-component text-on-left mobile-text-overlay" role="banner"> <style scoped> #i2fa2e7b87d3ff93417985fcedfb05f89-mobile-img { background-image: url("\2f content\2f dam\2fjmh\2f banners\2f f-sr-afam-group.jpg"); background-position: 100% 0%; background-repeat: no-repeat; background-size: cover; height: 350px; } .slick-cloned .banner-component .mobile-image { height: 350px; } </style> <div id="i2fa2e7b87d3ff93417985fcedfb05f89-mobile-img" class="mobile-image hide"> </div> <style scoped> @media (min-width: 1px) { #i2fa2e7b87d3ff93417985fcedfb05f89 { background-image: url("\2f content\2f dam\2fjmh\2f banners\2f f-sr-afam-group.jpg"); background-position: 100% 0%; background-repeat: no-repeat; background-size: cover; height: 500px; position: relative; top: -42pxpx; margin-bottom: -42pxpx; } .slick-cloned .banner-component .banner-wrap { height: 500px; } } </style> <div id="i2fa2e7b87d3ff93417985fcedfb05f89" class="banner-wrap"> <div class="aem-Grid aem-Grid--12 container content-wrap"> <div class="text-wrap bg-color-white o80 aem-GridColumn aem-GridColumn--lg--6 aem-GridColumn--md--6 aem-GridColumn--sm--12 aem-GridColumn--xs--12 md"> <h1 class="h3 blue-grey-text text-darken-4">Request a Medical Record</h1> <div class="blue-grey-text text-darken-4"> <p></p> </div> </div> </div> </div> </section> </div> <div class="breadcrumbs"> <link rel="stylesheet" href="/etc/clientlibs/jmh-components/breadcrumbs.css" type="text/css"> <script src="/etc/clientlibs/jmh-components/breadcrumbs.js"></script> <div class="breadcrumbs-component "> <nav class="container" aria-label="breadcrumbs"> <ol> <li class=" "> <a href="/"> Home </a> <span class="divider"></span> </li> <li class=" parent-page"> <a href="/patients-and-visitors.html"> <svg class="arrow" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" xml:space="preserve" viewBox="0 0 16 27" preserveAspectRatio="xMinYMin meet"> <polygon points="13.399999141693115,26.799999713897705 0,13.400000095367432 13.399999141693115,0 16.200000286102295,2.8000001907348633 5.599999904632568,13.400000095367432 16.200000286102295,24.000000476837158 "/> </svg> For Patients & Visitors </a> <span class="divider"></span> </li> <li class="active "> <a href="/patients-and-visitors/request-medical-record.html"> Request a Medical Record </a> </li> </ol> <div class="tools"/> </nav> </div> </div> <div class="columnComponent"> <article class="responsive-column-component colComp_20456 margin-top-lg-30 margin-bottom-lg-30 "> <div class="column-wrapper transparent o10 "> <div class="container "> <div class="aem-Grid aem-Grid--12 cell-padding" role="main"> <div class="aem-GridColumn aem-GridColumn--lg--4 aem-GridColumn--md--4 aem-GridColumn--sm--12 aem-GridColumn--xs--12"> <div> <div class="linkList list parbase"> <div class="link-list-component leftRailNav " role="navigation"> <link rel="stylesheet" href="/etc/clientlibs/jmh-components/linkList.css" type="text/css"> <script src="/etc/clientlibs/jmh-components/linkList.js"></script> <div class="link-list-title"> <a class="title " href="/patients-and-visitors.html"> For Patients & Visitors </a> </div> <div class="link-list-content"> <ul> <li> <a href="/patients-and-visitors/mjmh-find-out-more.html"> <span class="title">About MyChart</span> <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" xml:space="preserve" viewBox="0 0 16 27" preserveAspectRatio="xMinYMin meet"> <polygon points="13.399999141693115,26.799999713897705 0,13.400000095367432 13.399999141693115,0 16.200000286102295,2.8000001907348633 5.599999904632568,13.400000095367432 16.200000286102295,24.000000476837158 "/> </svg> </a> </li> <li> <a href="/patients-and-visitors/locating-patients.html"> <span class="title">Locating Patients</span> <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" xml:space="preserve" viewBox="0 0 16 27" preserveAspectRatio="xMinYMin meet"> <polygon points="13.399999141693115,26.799999713897705 0,13.400000095367432 13.399999141693115,0 16.200000286102295,2.8000001907348633 5.599999904632568,13.400000095367432 16.200000286102295,24.000000476837158 "/> </svg> </a> </li> <li> <a href="/patients-and-visitors/new-patients.html"> <span class="title">New Patients</span> <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" xml:space="preserve" viewBox="0 0 16 27" preserveAspectRatio="xMinYMin meet"> <polygon points="13.399999141693115,26.799999713897705 0,13.400000095367432 13.399999141693115,0 16.200000286102295,2.8000001907348633 5.599999904632568,13.400000095367432 16.200000286102295,24.000000476837158 "/> </svg> </a> </li> <li> <a href="/patients-and-visitors/patient-privacy-practices.html"> <span class="title">Patient Privacy</span> <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" xml:space="preserve" viewBox="0 0 16 27" preserveAspectRatio="xMinYMin meet"> <polygon points="13.399999141693115,26.799999713897705 0,13.400000095367432 13.399999141693115,0 16.200000286102295,2.8000001907348633 5.599999904632568,13.400000095367432 16.200000286102295,24.000000476837158 "/> </svg> </a> </li> <li> <a href="/patients-and-visitors/payment-and-insurance.html"> <span class="title">Payment and Insurance</span> <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" xml:space="preserve" viewBox="0 0 16 27" preserveAspectRatio="xMinYMin meet"> <polygon points="13.399999141693115,26.799999713897705 0,13.400000095367432 13.399999141693115,0 16.200000286102295,2.8000001907348633 5.599999904632568,13.400000095367432 16.200000286102295,24.000000476837158 "/> </svg> </a> </li> <li> <a href="/patients-and-visitors/preparing-for-surgery.html"> <span class="title">Preparing for Surgery</span> <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" xml:space="preserve" viewBox="0 0 16 27" preserveAspectRatio="xMinYMin meet"> <polygon points="13.399999141693115,26.799999713897705 0,13.400000095367432 13.399999141693115,0 16.200000286102295,2.8000001907348633 5.599999904632568,13.400000095367432 16.200000286102295,24.000000476837158 "/> </svg> </a> </li> <li> <a href="/patients-and-visitors/registration-forms.html"> <span class="title">Registration & Forms</span> <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" xml:space="preserve" viewBox="0 0 16 27" preserveAspectRatio="xMinYMin meet"> <polygon points="13.399999141693115,26.799999713897705 0,13.400000095367432 13.399999141693115,0 16.200000286102295,2.8000001907348633 5.599999904632568,13.400000095367432 16.200000286102295,24.000000476837158 "/> </svg> </a> </li> <li> <a href="/patients-and-visitors/request-medical-record.html" class="active"> <span class="title">Request a Medical Record</span> <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" xml:space="preserve" viewBox="0 0 16 27" preserveAspectRatio="xMinYMin meet"> <polygon points="13.399999141693115,26.799999713897705 0,13.400000095367432 13.399999141693115,0 16.200000286102295,2.8000001907348633 5.599999904632568,13.400000095367432 16.200000286102295,24.000000476837158 "/> </svg> </a> </li> <li> <a href="/patients-and-visitors/security-center.html"> <span class="title">Security Center</span> <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" xml:space="preserve" viewBox="0 0 16 27" preserveAspectRatio="xMinYMin meet"> <polygon points="13.399999141693115,26.799999713897705 0,13.400000095367432 13.399999141693115,0 16.200000286102295,2.8000001907348633 5.599999904632568,13.400000095367432 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0,13.400000095367432 13.399999141693115,0 16.200000286102295,2.8000001907348633 5.599999904632568,13.400000095367432 16.200000286102295,24.000000476837158 "/> </svg> </a> </li> <li> <a href="/patients-and-visitors/Nurse-Advice.html"> <span class="title">Nurse Advice</span> <svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" xml:space="preserve" viewBox="0 0 16 27" preserveAspectRatio="xMinYMin meet"> <polygon points="13.399999141693115,26.799999713897705 0,13.400000095367432 13.399999141693115,0 16.200000286102295,2.8000001907348633 5.599999904632568,13.400000095367432 16.200000286102295,24.000000476837158 "/> </svg> </a> </li> </ul> </div> </div> </div> </div> </div> <div class="aem-GridColumn aem-GridColumn--lg--8 aem-GridColumn--md--8 aem-GridColumn--sm--12 aem-GridColumn--xs--12"> <div> <div class="text parbase"><section class="text-component container blue-grey-text text-darken-4 text-align-left"> <link rel="stylesheet" href="/etc/clientlibs/jmh-components/ctaComponent.css" type="text/css"> <link rel="stylesheet" href="/etc/clientlibs/jmh-components/text.css" type="text/css"> <script src="/etc/clientlibs/jmh-components/ctaComponent.js"></script> <script src="/etc/clientlibs/jmh-components/text.js"></script> <div class="title-wrap"> <h3 class="h3" tabindex="0">Request a Medical Record</h3> </div> <div class="text-wrap fsize-16" tabindex="0"> <p>To receive a copy of your medical record or to authorize John Muir Health to release your medical information to someone else, you need to send your request in writing, including a signed <b>Authorization for Use or Disclosure of Protected Health Information</b> form (<a href="/content/dam/jmh/Documents/Registration-Forms/Authorization_for_Use_or_Disclosure_of_Protected_Health_Information3.pdf" class="ph link-pdf" target="_blank">English</a> or <a href="/content/dam/jmh/Documents/Registration-Forms/Authorization_for_Use_or_Disclosure_of_Protected_Health_Information-Spanish.pdf" class="ph link-pdf" target="_blank">Spanish</a>), to the Health Information Management department.</p> <ul> <li><a href="/content/dam/jmh/Documents/Registration-Forms/Authorization_for_Use_or_Disclosure_of_Protected_Health_Information3.pdf"><b>Authorization for Use or Disclosure of Protected Health Information</b></a></li> <li><a href="/content/dam/jmh/Documents/Registration-Forms/Authorization_for_Use_or_Disclosure_of_Protected_Health_Information-Spanish.pdf"><b>Autorización Para El Uso O Divulgación De Información De Salud Protegida</b></a></li> </ul> <p>Unless you are using the record for continuity of care, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. Upon receiving your request, we will let you know if there is a fee and how much. </p> <p>To submit your written request for Walnut Creek Medical Center, Concord Medical Center or Behavioral Health records, please email <a href="mailto:HIM@johnmuirhealth.com"><b>HIM@johnmuirhealth.com</b></a>, message via MyChart, mail, fax, or hand deliver your signed authorization form to the Health Information Management Department located at 5003 Commercial Circle, Concord, CA 94520. Our medical record department is open <b>Monday - Friday, from 9:00AM to 4:00PM. </b></p> <p><b>John Muir Health - Health Information Department<br /> </b>5003 Commercial Circle <br /> Concord, CA 94520<br /> <b>Phone: (925) 947-5373<br /> Fax: (925) 947-3235</b></p> <h5>Next steps after requesting medical records</h5> <ul> <li>Please allow up to 14 calendar days for your request to be processed. If you indicated the option to pick-up your medical records, you will be contacted by the Release of Information Office when your records are ready. A photo ID is required.</li> <li>If an individual other than the patient is picking up the records, then that individual must have an original signed authorization letter from the patient and a photo ID. <ul> <li>Learn how to request share access to a child's or adult patient's online health record at John Muir Health through <b><a href="/patients-and-visitors/mjmh-find-out-more/mjmh-set-up-access.html">Set Up Family Access</a></b>.</li> </ul> </li> <li>Once you have obtained and reviewed your records, if you find an error that requires correction, please discuss it with your provider or use the <b><a href="/content/dam/jmh/Documents/Patient-and-Visitors/Amendment-Request-Form_9_27_2022.pdf">Addendum or Correction to Medical Records</a> </b>form to request a correction/amendment. Please include a copy of the page(s) where the error(s) occur and the completed form. You will receive a written reply within 60-days but for more complex cases, this may be extended an additional 30 days.</li> </ul> </div> </section> </div> </div> </div> </div> </div> </div> </article> <style id="bgImage-colComp_20456"></style> </div> </div> <div> <div class="newpar new section"> </div> <div class="par iparys_inherited"> <div class="reference parbase"><div class="cq-dd-paragraph"><div class="fragment-par parsys"><div class="footerComponent parbase section"><footer class="page-footer blue-grey lighten-5 "> <link rel="stylesheet" href="/etc/clientlibs/jmh-components/footerComponent.css" type="text/css"> <script src="/etc/clientlibs/jmh-components/footerComponent.js"></script> <div class="container"> <div class="aem-Grid aem-Grid--12"> <div class="aem-GridColumn aem-GridColumn--lg--4 aem-GridColumn--md--4 aem-GridColumn--sm--6 aem-GridColumn--xs--12"> <div> <div class="columnComponent"> <article class="responsive-column-component colComp_98189 "> <div 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<p><a href="/patients-and-visitors/payment-and-insurance/patient-financial-assistance-program/patient-financial-assistance.html" class="linkComponent text-color-jmh-brand-grey-family-darker" target="_self"><b>Help Paying Your Bill</b></a></p> </div> </section> </div> <div class="text parbase"><section class="text-component container blue-grey-text text-darken-4 text-align-left"> <div class="title-wrap"> <h2 class="h2" tabindex="0">PRIVACY</h2> </div> </section> </div> <div class="linkComponent parbase"> <a href="/patients-and-visitors/patient-privacy-practices.html" class="linkComponent blue-grey-text text-darken-4 " target="_self" tabindex="0" rel="noreferrer"> Patient Privacy </a> </div> <div class="linkComponent parbase"> <a href="/content/dam/jmh/Documents/Legal-and-Privacy/website-privacy-policy.pdf" class="linkComponent blue-grey-text text-darken-4 " target="_self" tabindex="0" rel="noreferrer"> Website Privacy </a> </div> <div class="linkComponent parbase"> <a 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John Muir Health is not responsible for the content or policies of external websites. By clicking on this link you will be governed by the external site’s privacy policies.</h2> </div> </section> </div> <div> </div> </div> </div> <div class="footnote"> <div> <p><span>© </span><span id="copyright-year"></span> John Muir Health All rights reserved.</p> </div> <div class="joint-commission"> <p>John Muir Health is accredited by The Joint Commission. </p> </div> </div> </div> <script> if("ActiveXObject" in window) { if( window.require ) require(['jquery', "/etc/designs/jmh/clientlib-ie.js"], function($) { $( document.body ).append('<link rel="stylesheet" href="/etc/designs/jmh/clientlib-ie.css" type="text/css" /' + '>'); }); else { $( document.body ).append('<script src="/etc/designs/jmh/clientlib-ie.js"></' + 'script>') .append('<link rel="stylesheet" href="/etc/designs/jmh/clientlib-ie.css" type="text/css" /' + '>'); } } // insert current year in the footer. var date = new Date().getFullYear(); document.getElementById("copyright-year").innerHTML = date; </script> </footer>    </div> </div> </div> </div> </div> </div> </div>  </body> </html>

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