Your privacy is very important to us. Community Memorial Health Information Management is responsible for securely maintaining and protecting our patients’ medical records. To comply with state and federal law, we may only release a copy of a medical record with proper authorization from the patient or a designated representative.
Authorization for Use or Disclosure of Health Information
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Psychotherapy Notes Authorization for Use or Disclosure of Health Information
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Spanish
You may also choose to have your physician call and request documentation necessary for an appointment ahead of time. This will ensure any necessary reports, results and/or documentation are available at the time of your visit. COVID-19 test results may be obtained by the physician who ordered the test.
After your completed request has been processed, we will deliver the documents in the requested format and delivery mode. Please be advised that when utilizing email there is some level of risk that your health information could be read or otherwise accessed by a third party while in transit.
Please call us at 805-948-5047 for assistance with the following:
Request current fee schedule
Amend your medical record
We will provide you with a “Request for Amendment of Protected Health
Information” form. Complete and sign amendment form and return via
mail, fax, or email. Requests take 7 – 14 business days to process.
Unsigned or incomplete requests cannot be processed.
Receive an "Accounting of Disclosures"
We will provide you with an "Accounting of Disclosures" form.
Complete and sign this form and return via mail, fax, or email. Requests
take 7 – 14 business days to process. Unsigned or incomplete requests
cannot be processed.
You may submit completed forms in the following ways. To protect your privacy and health information, we do not accept phone requests or disclose patient information over the phone.
Community Memorial Healthcare
Attn: Medical Records/ROI
147 N. Brent Street
Ventura, CA 93003
Community Memorial Medical Records
805-948-5649
Email your completed request in a PDF format to ROIrequests@mycmh.org
Phone:
805-948-5047
Hours: Monday – Friday, 8:00 am – 4:30 pm
Closed for the following Holidays: