Skip To Content

Medical Records

The Health Services shall not voluntarily use the medical records in any manner that will jeopardize any of the rights or interest of the patient. Every staff member, including student assistants, must respect the confidentiality of patient records. Other than members of the staff directly involved in the care of the patient, no one may read or receive a copy of any part of the patient's record with the following exceptions:

  • With written permission of the student or his/her parent or guardian if he/she is a minor, a copy of part or all of a medical record may be sent to an outside physician, medical facility or other institution.
  • With written permission of the student or his/her parent or guardian if he/she is a minor, copies of pertinent records may be provided to attorneys, investigating agencies, or copying services.
  • Cases in which legal statues require reports to be made: e.g., contagious diseases, gunshot wounds, child abuse, sexual assault, etc.
  • Industrial cases in which all, or part of a medical record, are subpoenaed by order of the court.

There are some exceptions to the above conditions as stated by the Medical Board of CaliforniaA physician may refuse to release a minor's records whether or not requested by the minor or the minor's representative, if the physician feels that the information may be detrimental to the mental or physical health of the patient, or that it may negatively impact the relationship between physician and patient. Along the same lines, a physician may refuse a patient's request to see his or her mental health records if the physician deems it may be detrimental to the physician/patient relationship.

How to Obtain a Copy of Your Medical Records

A student may receive copies of his/her record by completing an Authorization for Release of Medical Information form, or if the student wishes to review his/her medical record, an appointment with a clinician must be made, and the clinician will review the record with the patient. All medical records are kept on file for seven (7) years from the date of the last entry.

A parent of an adult patient (over 18 years of age) or of an emancipated minor is not entitled to receive confidential information about the patient unless the patient gives written permission (see procedure above).

Medical records will be accessible only to members of the Student Health Services staff who are currently working with the patient.

Instructions for Filling out Medical Release Form

  1. Decide where you want the information to come FROM ("Student Health Services") and where you would like for it to be sent, along with complete address and doctor's name, if known.
  2. Fill out the personal information of the patient, including name, address, etc. Bronco Number must be listed. If you do not know it, use the student ID# at the time you were a student.
  3. The "Duration" date should be a year from the date of signature.
  4. Specify which records you would like to be released. If an additional signature authorization is required, please sign after printing. Make sure to check which type of record is being requested.
  5. Be sure to sign the release in all areas indicated after you print it out. Fax, mail (see info on form) or bring the form into SHS in person. Completed and signed forms can be scanned and emailed to: sratkins@csupomona.edu 
  6. Records are $.20/page, $1.00 minimum unless records are being sent directly to a doctor or other medical facility. If you wish a copy for yourself, you will be contacted as to the cost and payment must be made in advance before records are released.