Medical Record Request


As our patient, NEVHC values the privacy of your health information. We will not release or otherwise divulge information about you/your health without your permission unless we are permitted or required to release information pursuant to a legal action or a government mandate.


1. When may NEVHC release my information without my consent?

A: Please review our Notice of Privacy Practices for all the ways NEVHC uses your information and limits your health care information. This document will also provide guidance on times when we are mandated to provide information about you to third parties.

2. Are there costs for me to obtain a copy of my NEVHC medical information?

A: Yes, there are costs. NEVHC charges a $15 administrative fee plus 25 cents per page copying fee up to 200 pages and then 12 cents thereafter. The maximum charge is $400 for electronic or paper (mail) delivery. If you just want a few pages of your record, we allow a patient to obtain copies of up to 5 pages of their record at no cost. If you have access to the NEVHC patient portal, you may access parts of your record through the portal to view and download.

3. What is the procedure if I need my health record (or parts of it) to be sent to another provider?

A: If you are being referred by NEVHC to another provider, we will automatically send relevant information about your case to that provider as long as you have verbally consented to the referral. If you are requesting your health information to be released to other providers or third parties, you must authorize the release of this information in writing by completing an Authorization to Release  form. Return the form to the Business Office or Medical records department of your NEVHC health center location. You can also FAX the form to our Medical Record Coordinator’s office at (818) 270-9271.


4. What if I want to review information in my medical record? Are there costs to do this?

A: You have the right under the Health Information Portability and Accountability Act (also known as HIPAA) to request an appointment to review your medical information. Please call the medical records department at your health center to request to review your record. Let them know what you wish to review. There is no charge to do this. If you have any questions about information in your record and you want to speak to your provider about that information, you need to request a separate appointment with your provider to review your information.


5. Who can I call if I have further questions about release of my information to me or a third party?

A: For questions regarding a request for release of information, please contact the Medical Records department at your health center location. For general information, contact the Medical Records Program Coordinator’s office at our San Fernando Health Center at (818) 898-1388 ext 52202.

6. What do I do if I feel that NEVHC has violated my confidentiality? Who should I discuss this with?

A. NEVHC has a Privacy Officer whose job is to thoroughly research all allegations related to breaches of patient confidentiality. You may call the Privacy Officer at: (818) 898-133 ext. 41645. The Privacy Officer is also responsible for reporting those breaches to government entities on behalf of you as required.

NEVHC contracts with an offsite vendor, Iron Mountain, in Denver, CO, to manage the release of all third party requests. To request patient records, please use one of the following methods:

MAIL Request to:

Northeast Valley Health Corporation, 1600 San Fernando Rd, San Fernando, CA 91340
FAX Request to: (818) 270-9271
PRESENT a subpoena or court order at:

Northeast Valley Health Corporation, 1600 San Fernando Rd, San Fernando, CA 91340. Ask for the Medical Records Coordinator.
EMAIL to: medicalrecords@nevhc.org
For any additional information about Medical records at NEVHC, contact the Chief Operations Officer at (818) 8981388 ext. 41624.

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