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Medical Records Office

Health Records Office hours:
Monday-Friday, 8:00am - 4:00pm (Closed Major Holidays)
Phone: (626) 570-6630 Fax: (626) 457-4791

Requests for Medical Records

To begin the process of obtaining copies of your medical records, please print and complete the AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION.

If you need to have copies of your record released to another individual or hospital, please print and complete the form entitled Authorization for Use or Disclosure of Protected Health Information and provide the name, address and/or fax number of the third party receiving your medical records.

In order for Health Information Management (Medical Records) to process your request, all information requested must be provided.

Please submit your completed form(s):

E-mail the completed form, along with photo ID to

Mail the completed form with copy of photo ID:

ATTN: Health Information Management
438 W Las Tunas Drive,
San Gabriel, CA 91776

Fax the completed form, along with photo ID to (626) 457-4791

If you are unable to print the above forms, please call the Health Information Management Office at (626) 570-6630 during normal business hours.

Once your request is received by Health Information Management, it will be processed in the order it was received.

Medical records will be faxed or mailed to another hospital or physician's office if requested by a completed Authorization for Use or Disclosure of Protected Health Information.

A spouse, relative or friend cannot obtain a copy of your medical records, or pick up records for you, unless the individual has Power of Attorney for Healthcare Decisions for you. A copy of the Power of Attorney for Healthcare Decisions must be included with your request.

The pertinent part of the medical record is available to patients at no charge. This includes the discharge summary, history & physical, consultations, procedural reports, radiology (diagnostic imaging) and laboratory reports.

For copies of additional portions of the medical record, a fee of 25 cents per page will be charged to you. A bill may be mailed prior to the records being copied and sent to you. Money orders will be accepted via mail made out to San Gabriel Valley Medical Center. There is no charge if the copies of the records are sent to physicians for your follow up care or treatment.

Birth Certificates

Birth certificates are processed at the hospital by Health Information Management and sent to the State of California for issuance. Contact the State of California, or local county registrar recorder's office to obtain a birth certificate. San Gabriel Valley Medical Center does not issue birth certificates. If the child is under two years of age, you may request a copy from the Los Angeles County Vital Records Birth Registrar's Office (Vital Records Office) located at 313 North Figueroa Street: Room Lobby 1, Los Angeles, CA 90012. The phone number for the Vital Record's Office is (213) 288-7812. Information can be obtained on their website at The current fee for a birth certificate is $32.00.

If you cannot apply in person, you may complete an application and send a notarized statement with the application and the fee (check or money order to the County of Los Angeles). A copy of the birth certificate can be requested from the Los Angeles County Registrar Recorder. Please address your request to: Attention: Birth Certificates, 4716 E. Cesar Chavez Ave., East Los Angeles, CA 90022, the website is For more information, contact the Recorder's Office at (800) 201-8999.

Death Certificates

Death certificates are not issued by the hospital. Information on obtaining death certificates may be obtained from or Death certificates occurring within the county of Los Angeles, except for Long Beach and Pasadena, may be obtained from the Vital Records Office for the current year and prior year. The fee is $24.00 and pertains to County Deaths only from the year 1877 forward.
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