A patient over the age of 18 or his/her legal representative, may obtain a copy of their medical records. As a courtesy to our patients we process “walk-in requests” the same day for CD’s, radiology reports, labs and records up to 30 pages. Picture ID is required. Marin General Hospital requires a completed and signed Authorization for Release of Health Information form before releasing any documents to anyone, including the patient. In certain cases, a patient's physician, psychologist or social worker may also be required to approve a request made using a release form. We do not accept fax requests from patients.
How to request a copy of your medical records:
Print and complete the Authorization for Disclosure of Health Inform form:
- Medical Records Release Authorization Form (English)
- Medical Records Release Authorization Form (Spanish)
The release form must be completed, dated and signed and a valid color copy of your photo ID attached. We ask that you specify what components of your medical records you wish to obtain. Often, the discharge summary, operative report and history and physical contain relevant information to suit your needs. Requests must be specifically signed/initialed if requesting/authorizing the following information:
- Psychiatric Care
- Substance Abuse
Mail the completed form to:
Marin General Hospital
C/O Medical Records Dept.,
250 Bon Air Road, Greenbrae, CA 94904
Acceptable forms of original photo ID include:
- Driver’s license
- Immigration Documentation
Release of information charges:
- No charge for up to 30 page count
- $0.25 per page 31 pages and over
- Radiology images/CD’s $5.00
If you have any questions regarding release of health information, please call 1-415-925-7270. Your request will be processed within 15 days. We will either mail a copy of the medical records to the address you provide or you may pick up your copy during office hours. Please stipulate your preference. We will call when they are ready.
A patient’s personal representative must bring their picture ID and the durable power of healthcare. If the patient is deceased, the personal representative must provide proof of being the executor or administrator of the estate and provide the patient’s death certificate.
If you believe your health information was used or shared in a way that is not allowed under the HIPAA privacy law, or if you weren’t able to exercise your rights, you can file a complaint with your provider or health insurer. You can also file a complaint with the U.S. government.
A separate law provides additional privacy protections to patients of alcohol and drug treatment programs.