Physicians who refer patients to Shriners Hospitals for Children — Northern California will receive a note from the patient’s first visit. If other questions arise, please call health information services at 916-453-2164 for assistance.

To request copies of your own medical records, or to authorize the disclosure of your medical records to another individual or third party, you will need to complete a HIPAA compliant form and submit your request in writing to the Health Information Services (HIS) department. Note: Please be sure to complete all sections when filling out the form.

Patients, legal guardians and personal representatives with legal authority to make health care decisions on behalf of the individual may obtain medical record copies by completing a Patient Request for Information form. (English) (Español)

Third parties may obtain medical record copies by submitting an Authorization for Disclosure of Health Information form that is completed and signed by the patient and/or legal guardian. (English) (Español)

Fax the completed forms to 916-453-2355, or email to NCL-HealthInformation@shrinenet.org.

Family requests

Families may also request copies of their patient medical records.