How to request Medical Records
If you need copies of your medical or billing records, please see below instructions: There may be a delay on our usual 5-7 day completion period due to safety precautions being taken amid the COVID-19 pandemic. Currently we will not be printing any records, and XR requests will be processed once a week until further notice. We ask that you email your records request to email@example.com or send your request through your patient portal.
EDD FORMS - If you want to start a disability claim please fill out your portion online at the EDD website and record your Receipt Number then use your patient portal to send us your Receipt Number along with any specific start or return to work dates.
Records Release FROM Alta
To request your Medical Records from Alta, please print the Medical Records Request form (below) and email to firstname.lastname@example.org(please do not email other documents) or you may fax it to 805-962-2154. We will notify you as soon as your records are ready.
Please note: Due to security and privacy purposes requests via phone will only be granted if you are picking up records at our office. Please allow 5 to 7 business days for request to be processed. If you are requesting x-rays, there will be a $10 fee due upon request per disc.
If you are not the patient and are requesting medical records or medical information we must have a signed release from the patient authorizing you to obtain this information. View the Consent to Disclose Information Form below.
The Consent to Disclose Information form must be filled out at the office, as it must be signed by an Alta Staff member as a witness.
CONSENT TO DISCLOSE INFORMATION
Records Release TO Alta
To have medical records requested BY Alta on your behalf, fill out the Request for Outside Medical Records. Once you have completed this form, please fax the request to 805-962-2154, and we will submit the form on your behalf. Your original MD may contact you for additional information, but we’re happy to initiate the process and collect your medical records upon request.
The following forms are subject to a $25 processing fee:
FMLA (from employer or private insurance)
Forms from employers, schools, and daycare
Medical Certification forms
Attending physician statements
Subpoenas for records can only be mailed or dropped off with payment. Please do not fax request.
Our pick up hours are Monday through Friday, 8am to 5pm and we are open during lunch hours.
The fee for copies of records is $15 per file/chart an additional $15 if requesting billing records. Payment is due at time of request.