For your convenience the below documents are available to download and print. This will allow you to fill out your forms prior to your first appointment. Please remember to bring them with you on the day of your visit. Thank you!

• Medical Records Release Form - Authorization for Release of Protected Health Information
  • Autorización para Revelar Información de Salud Protegida
• Requested Use or Disclosure of Protected Health Information Potentially Related to Reproductive Health Care
  • Uso o Divulgación Solicitado de Información de Salud Protegida Potencialmente Relacionada con la Atención de la Salud Reproductiva 
• Request for Correction and Amendment of Protected Health Information
  • Solicitud de Corrección y Enmienda de Información de Salud Protegida
• Request for Restriction and Limitation of Protected Health Information
  • Solicitud de Restricción y Limitación de Información de Salud Protegida
• Request For Accounting of Disclosure of Protected Health Information
  • Solicitud de Contabilización de Divulgación de Información de Salud Protegida

Requestors can use VitalChart’s Online Request Portal to submit a request for medical records. Patients and requesters can receive records within a 24–48-hour timeframe from submission. VitalChart provides customer service for patients and requesters seeking information on instructions using the request portal, record release status and more. Patients are still able to request their medical records in office by filling out the Medical Records Release Form and faxing requests to 916-924-8281.

FAQ

How can I reach Vital Chart customer support?

Vital Chart customer service line: (972) 399-0914 or PediatricassociatesCA@vital-chart.com.

Can I still access/ request my medical records through the Patient Portal?

Yes, patients are still able to log in to their patient portal and request partial medical records through the platform. If a patient needs their medical records for a more serious instance such as police reports, CPS, change of Primary Care Provider, etc. Vital Chart must be used to request medical records.