Release of Information/Records
A patient, or his/her legal representative, may inspect and/or obtain a copy of their medical records, or have copies of medical records sent to another facility.
Anka Behavioral Health, Inc. requires a completed and signed Authorization for Release of Health Information form before releasing any documents to anyone, including the patient. In certain cases, a patient's physician, psychologist or social worker may also be required to approve a request made using a release form.
If you have questions about this process, please feel free to contact us at email@example.com
How to Request a Copy of Your Medical Records
- Complete the Authorization for Release of Information (PDF) Form.
- The release form must be completed, dated, and signed. An e-signature is acceptable.
- Submit the completed form with a copy of your driver’s license or government ID via e-mail to firstname.lastname@example.org or by mail to:
Attn: Records Request
3480 Buskirk Ave., Suite 300
Pleasant Hill, CA 94523
Release of Medical Information Fees
- A fee of $0.10 per page will be invoiced to the entity/person requesting the records after the release form has been received.
Next Steps After Requesting Medical Records
- It can take up to 30 days to have the request filled and returned to the requested location.
- If you need the request taken care of before that time frame please state that in the initial e-mail sent. We will try to accommodate your request in a timely manner.