DBH medical records are maintained in a secure manner and are released only with a completed authorization form and only to:
- A client requesting his or her behavioral health medical records or
- A recognized entity with a legal right to review the contents.
Consumers may request a copy of his or her behavioral health medical records with a properly completed Authorization for Release of Protected Health Information form. Please download, print, and fill out the form completely. Authorizations not appropriately signed will not be processed. An $0.25 per page fee applies to receive copies of the medical record. Minor children between the ages of 12 and 17 may need to sign his or her own authorization. Prior to release, personal access release requests for medical records need to be approved by designated DBH staff.
Access to Medical Records Request
Solicitud de Acceso a los Registros Médicos
Authorization for Release of Protected Health Information
Autorización Para Divulgar Información Médica Protegida
Protected Health Information (PHI) Fee Schedule (English)
Protected Health Information (PHI) Fee Schedule (Spanish)
Completed forms can be presented to the clinic where the consumer is currently being seen. For consumers that are not currently being seen, the request can be sent to the Medical Records Unit.
For more information, call (909) 421-9350 or email DBH-MedicalRecords@dbh.sbcounty.gov
Q: Is there a charge for copies?
A: A flat fee of $ 0.25 per page is the cost for copies of records for personal use. Please refer to the Authorized Release of Protected Health Information (PHI) Fee Schedule.
Q: May my spouse request and receive copies of my medical record?
A: Only with an appropriately signed Authorization for Release of PHI form or legal paperwork identifying the spouse has rights to request medical records
Q: When can I expect to receive my copies?
A: It may take up to 15 days to fulfill your request. Requests for behavioral health records will require approval by the DBH treatment team.
Q: Can the copies be mailed to me?
A: Copies will be mailed to the address specified on the Authorization for Release of PHI form or you may pick them up during hours of operation. Please indicate your preference on the release form.