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MEDICAL RECORDS FORM

Dear Patient/Family Member,

 

If you are interested in obtaining a copy of the pertinent information from your medical record for your personal use, or would like it  sent to another  healthcare provider, please complete the Authorization form and mail or fax it. (See information below).

 

Click here for the "Authorization to Use and Disclose Protected Health Information" form.

 

 

You can either mail the completed authorization to:

 

HIM Dept.

Olympia Medical Center

5900 W. Olympic Blvd.

Los Angeles, CA  90036

 

Or you may fax to 323-932-5376.

 

They may be a fee for the copying and mailing of your medical record.   If you have any questions, please contact us at 323-932-5275.

 

Sincerely,

 

Health Information Management

 

Olympia Medical Center is an Alecto Healthcare Hospital. Our 204-bed acute care medical/surgical facility, provides award-winning inpatient and outpatient diagnostic, medical and surgical services to our communities.