General Information

California State Laws and Federal Regulations allow for the use and disclosure of protected health information. Specific circumstances require an appropriate authorization from the patient or personal representative. Authorization forms are available in the Medical Records Department. There are specific types of information in which release is limited or restricted, including but not limited to Psychiatric, HIV Results, Adoptions, etc. Identification is required. If the consent is signed by someone other than the patient, supporting identification and/or documents may be necessary.

Business Hours

We are open to the public from 9:00AM - 5:00PM Monday thru Friday, except for holidays. Special arrangements may be made for after-hours business transactions by calling (661) 949-5011.

Response Time

We make every effort to respond in a timely manner to your request for release of information. Our goal is to process your request within five (5) working days from our receipt of the completed consent.

Copies For Continuous Care

Your continuing care is important, we understand this need. Information that we mail or fax directly to a physician or hospital will be processed free of charge. Though we work with you to have information available at medical appointment time, we will appreciate any advance notice you can give us.

Patient Access/Request For Copies

Federal Privacy Regulations and California Health & Safety Code make provisions for patients or personal representatives to have access to their records except in very limited situations. The law specifies the time allowed for providing each type of access and for allowable charges required before access is provided. Charges are defined as follows:

Change
Copy cost: Standard Size Pages 25 cents per page
Pages from Microfilm 50 cents per page
Photograph reproduction Actual Cost


Clerical cost: $1 processing
Postage: Actual Cost
Sales Tax: 8.25% as required by the State of California Sales and Use Tax Regulation 1528.


Deposit Required: A $5 deposit is required if number of copies are estimated to exceed 30 pages. Deposit will be applied toward total cost. If it is estimated that the total cost of the request will exceed $50 then a 50% deposit will be required before request is processed. If charge exceeds cost amount due will be refunded. An itemized bill and receipt will be provided.

Payment of Charges: Payment is required at time copies are picked up or prior to mailing. Payments must be made in full either by cash, check or credit card (with proper Identification) payable to Antelope Valley Hospital.

Copies of records will be held for pick-up for 30 days unless you make other arrangements. Copies will be destroyed after 30 days, deposit will not be refunded, and a new deposit will be required for any new requests.

Personal Representative

A "Personal Representative" is any of the following:

For an incompetent adult:

• A conservator of the patient's person.
• An agent appointed by the patient under a power of attorney for health care.

For a minor who does not have a special legal authority to sign an authorization:

• Parent
• Guardian
• Any other person in loco parentis

Any other individual who has the legal authority to make health care decisions on the patient's behalf (e.g. person who is the next-of-kin to a resident in a skilled nursing facility; person legally obligated to financially support patient); or

An executor or administrator of the patient's estate or any beneficiary who stands to inherit property from the patient, if the patient is deceased

For more information about your privacy rights, see the "Notice of Privacy Practices" available on this website and in the Medical Records Department.

NOTE: This information sheet is intended to furnish you with basic information regarding the release of Medical Records. It does not cover all aspects of use and disclosure of protected health information.