Medical Records
 

In compliance with patient confidentiality privacy laws, health information may not be released without a patient’s written authorization. To request medical records, you must submit an Authorization for Release of Medical Information. Signed and completed authorization forms may be submitted online, in person, by fax, or by mail.​

*Please see tutorial video on “How to Request your Medical Records​


Obtaining Medical Records

​​​How can I obtain my medical records?

Immunization Records, Billing Statements for the last 24 months, and Lab Results (starting from April 2016) can be accessed online through the patient portal. To log on, you must enter your UCLA log-on ID and password. Please click here​ to log in.

  • If you need assistance logging into the patient portal, please see FAQ #4, #5, #6.
  • If you need records prior to that or need more detailed information, please make a request using the procedure below:

Online    

  1. Click here, Authorization for Release of Medical/ Billing Information Form - Electronic
  2. For current students, use your UCLA login information to log in. Alumni who cannot log in will have to proceed by printing the paper authorization form listed below.
  3. Complete, sign and submit the form online. 

In Person, Fax or Mail

  1. Click here, Authorization for Release of Medical/ Billing Information Form - Paper​
  2. Download, print, complete and submit the form via fax, mail or in-person.
    • FAX: (310) 206-8012
    • IN-PERSON: You may also complete the authorization form in-person at our office located on the 4th Floor, Room 418 of the Ashe Center during business hours (Monday-Friday, 9:00 am-4:30 pm).
    • MAIL: Send the completed form to the address below 

Mailing Address:

UCLA Ashe Center
Medical Records Office
221 Westwood Plaza, Room 418 
Los Angeles, CA 90095-1703

Please Note:

  • Please specify the type(s) of health informa​tion and treatment date(s) on your release form.
  • Unsigned and/or incomplete requests cannot be processed. Please allow 7-10 business days for us to process your request.
  • Records involving HIV test results can only be picked up in person.​ 
  • Ashe Center only holds student medical records for 10 years.
  • Only immunization documents that were provided to The Ashe Center from a previous provider(s) or completed at the Ashe Center are included in our Immunization Record.​

Fees
  • There is no fee for current or past students.
  • For third parties (Outside Provider, Law Firm, or Facility), there is a $15 processing fee, please address the check or money order to “UC Regents."
For More Information

Please look over our Frequently Asked Questions (FAQs)​.
For further assistance please call (310) 825-4694.​