Requesting AHP Medical Records - Arch Health Partners

How to Request Arch Health Partners Medical Records
A patient, or his/her legal representative, may inspect and/or obtain a copy of medical records, or have copies
sent to another provider of health care. Please follow these steps:
1. Complete and sign an “Authorization for Use or Disclosure of Health Information” form.
• This form may be obtained in the Medical Records Department or on‐line at www.ArchHealth.org.
You may also call the Medical Records Department directly at (858) 675‐3199 to have one mailed
or e‐mailed to you.
• Be sure to complete all sections in order for the authorization to be valid.
• Be specific in the time‐frame and the type of records you are requesting.
For continuing care, we will automatically provide the most recent 12 months of doctor’s notes,
operative reports, lab results and other test reports. We will also provide pertinent reports from
other providers that have been sent to us for your continued care. X‐ray films will be provided
upon request for continuing care only. If you desire a copy of the film for personal use we will
provide instructions on how to obtain it.
• Who may sign: The patient, the patient’s legal representative, the patient’s beneficiary, or the
patient’s personal representative.
Please supply a copy of the supporting document, for example, legal guardianship papers. If
the patient is deceased, provide the death certificate or other legal documents. See below for
the required specific document types.
2. Deliver the completed form to Medical Records.
• In person or by mail: Medical Records Department, Suite 400,
15611 Pomerado Road,
Poway, CA 92064
Hours of Operation: 8 a.m. – 5 p.m., Monday‐Friday
• Fax to (858) 673‐5187
• Email: Request@Archhealth.org
3. Make Payment
• Medical records for continuing care to another provider of health care will be provided free‐ofcharge.
• Medical records for the patient’s personal use:
o Up to 20 pages, free of charge.
o 21 or more pages, 10 cents/page.
o Electronic media: Actual staff time utilized at $16/per hour.
o If the medical record is held in an off‐site storage location, there will be a retrieval fee of $20, or
the actual charges from our commercial vendor.
o If the records are to be mailed, actual postage will be charged.

o If charges are likely to exceed $50, we will ask for a deposit of $50‐$100 depending on the
records requested.
• Payment shall be made when records are picked up or if records are mailed, an invoice will be
included. Payment is appreciated within 10 days.
• We accept cash, check or credit/debit card.
4. Allow Time for Processing
• It may take up to 10 days to make the record copies available. The actual time needed depends on
various factors. If you need the records urgently, please tell our staff and we will try to
accommodate you the best that we can.
5. Picking‐up Your Copies
• Be prepared to show valid identification such as driver’s license, military ID, etc.
• If someone other than the patient needs to pick up the copies, they must be provided with a signed
letter from the patient that allows them to do so, being sure to specify the recipient by name.
6. We will mail or fax your medical records to your physician, or you may hand‐carry them.
______________________________________________________________________________
Who May Sign
Legal Representative: The requestor must be named in the document.
‣ Advance Health Care Directive
‣ Letter of Conservatorship
For Deceased patients: The requestor will be asked to provide proof that the patient is deceased and proof that the
requestor is the beneficiary or personal representative, as defined by California State law.
‣ The patient’s will
‣ Final Order of Distribution
‣ Letter of Executorship
‣ Letter of Administration
When the Patient is a Minor
‣ Either parent, unless one parent has Sole Custody
‣ Legal Guardianship
‣ For Emancipated Minors: An identification card issued by the DMV
‣ A minor patient may sign the Authorization when release is for records on treatment to which the minor can
legally consent, for example, treatment or prevention of pregnancy.
When the request is for the sole purpose of applying for health insurance or for enrollment in another type of health
plan, the spouse or person financially responsible may sign, under certain circumstances. Please refer to the Manager,
AHP Medical Records Department.