Release of Information

Patients and/or their legal representatives may request to obtain a copy of their medical records or have copies of their medical records sent to another facility. Per office policy, the Health Insurance Portability and Accountability Act (HIPAA), and California law, West Coast Sports Institute requires a completed and signed Authorization for Disclosure of Health Information form before releasing any documents to anyone, including the patient.

How to Request a Copy of Medical Records

  • Print and complete the Authorization for the Use or Disclosure of Protected Health Information form HERE
  • The release form must be completely filled out, dated, and signed by the patient
    • Minors may have a parent or legal guardian sign on their behalf
    • If requesting records are to be sent to multiple locations or are for multiple patients, please fill out a form for each individual entity
  • If not requesting complete records in their entirety, please specify what components of your medical records you wish to either obtain/release or exclude. Often times office visit notes, injection reports, operative reports, etc. may contain relevant information that fulfill your needs

How to Submit Your Request for Medical Records

  • You can deliver your forms in person, by mail, or by fax 
  • Deliver or mail requests to:
    • West Coast Sports Institute | 900 Lafayette St Suite 105 Santa Clara, CA 95050
  • Medical record requests can also be faxed to: (408) 300-9663 
  • Office Hours: Monday – Friday, 8:30 a.m. – 5 p.m.
    • Closed on weekends and holidays, check office website or call for more details

Cost for Release of Medical Records

  • No charge for records sent directly to another physician’s office or health provider
  • For patient requests:
    • First 25 pages free, $0.10 cents/page following the initial 25 free pages
  • For all other requests:
    • $25 for e-medical records delivered via electronic methods (E-fax, upload portals, etc.)
    • $50 for hard copy medical records printed to be mailed or picked up
  • In some cases, there may not be any fees for receiving your requested medical records. You will be notified in advance if any fees apply regarding your request.
  • Please send and make checks payable to West Coast Sports Institute at the address listed above
  • We also accept payments via credit card for faster processing: (408) 293-7767 ext 414
  • Per office policy, WCSI must receive payment before the authorized release of requested medical records
    • On a case by case basis, alterations may be permitted if pre-arranged with our office (paying for records at time of pick up, etc.)

After Requesting Medical Records

  • Please allow 5 to 7 business days for your request to be processed, though many requests are completed sooner
  • If invoiced for your medical records request, please allow 3 to 5 business days for your request to be processed upon receipt of payment

Additional Information

  • If indicated that you want to pick up your records in person, you will be contacted by our offices when they are ready for pick up
  • If planning to have someone else pick up your records, please make sure they have a photo ID and signed, original authorization letter from you upon pick up
  • Please note, due to security reasons and in compliance with overarching rules, we cannot release medical records via e-mail
  • If you have any questions regarding the release of health information from WCSI, please call (408) 293-7767