Requests for Medical Records
To begin the process of obtaining copies of your medical records, please
print and complete the form entitled "Patient's Request for Access to 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."
In order for Health Information Management to process your request, all
information requested must by provided.
Please fax your completed form(s) to (626)570-5700 or mail to:
Monterey Park Hospital
900 S. Atlantic Blvd.
Monterey Park, CA 91754
If you are unable to print the above forms, please call the Health Information
Management Office at
(626) 570-9000 Ext. 5263.
Once your request is received by Health Information Management, it will
be mailed to you unless arrangements are made to pick up your copy.
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.
Records from the Behavioral Medicine Center are released with authorization
by the attending psychiatrist.
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 Monterey Park Hospital. There is no charge if the copies of the
records are sent to physicians for your follow up care or treatment.
Birth certificates are processed by the Health Information Management Department
and sent to the State of California. Monterey Park Hospital does not issue
If the child is under one year 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 1, Los Angeles, CA
90012 . The phone number for the Vital Record's Office is (213) 240-7812.
Information can be obtained on their website at
www.publichealth.lacounty.gov. The current fee for a birth certificate is $23.00.
If you cannot apply in person, you may request an application in writing.
Send a letter with your name, your baby's name, date and place of
birth to the above address. You will need to send a notarized statement
with the application and the fee (check or money order to the Department
of Health and Human Services) to the above address.
If the child is over one year of age, a copy of the birth certificate can
be requested from Los Angeles County Registrar Recorder. Please send address
your request to: Attention: Birth Certificates, 4716 E. Cesar Chavez Ave.,
East Los Angeles, CA 90022, the website is
www.lavote.net. For more information, contact the Recorder's Office at (323) 260-2991.
Death certificates are not issued by the hospital. Information on obtaining
death certificates may be obtained from
www.lavote.net. The fee is $16.00 and pertains to County Deaths only from the year 1877 forward.