Providing assistance to physicians for completion of patient medical records.
Completing an Authorization From
The Health Insurance Portability and Accountability Act, also known as HIPAA, requires hospitals to obtain an original, complete, and properly executed “Authorization for Use or Disclosure of Protected Health Information” form in order to provide a copy of a patient’s medical record to a patient or anyone she or he designates. Only the patient, parent/legal guardian, or the patient’s legal health care representative can sign the form to release medical records.
The authorization form must be legible and complete. Authorizations that are illegible or incomplete will be returned. Requests for information regarding any of the following items must also be specifically initialed on the form:
- Chemical Dependency
- Mental Health
During COVID-19 please call us and we will mail an Authorization to you or you may pick up a form from the Receptionist in the Front Lobby. You can also access the Authorization form at the links below.
Submitting The Authorization Form
Once your “Authorization” form is completed, you may submit your request by mail, fax, or in person.
Mail or In Person
Community Hospital of Huntington Park
Attn: Health Information Management Department
2623 E. Slauson Ave.
Huntington Park, CA 90255
Records released to a Physician’s Office or a Medical Facility are free of charge.
Please note that medical records do not contain any billing information. For questions about your Community Hospital of Huntington Park’s bill, please call the Central Business Office at (562) 968 5600.
On behalf of Community Hospital of Huntington Park, we sincerely appreciate serving you. We deeply value your relationship with Community Hospital of Huntington Park and we are committed to providing you with the highest level of service because our customers deserve the very best.
(Medical Records Department)
Open Monday-Friday, 8 am – 4 pm
Closed during lunch from 12 pm – 1 pm
Huntington Park, CA 90255 2623 E. Slauson Ave.,