Health Information Management Services (HIMS/Medical Records)

Learn more about the following information concerning managing your health information: 

How To Obtain Your Health Information/Medical Records

City of Hope recognizes your right to access, obtain a copy or request to make a correction to your health information/medical records maintained by City of Hope. When you or your authorized representative or a third party (e.g., insurance company) request health information/medical records, we uphold strict guidelines adhering to state and federal privacy statutes when processing requests. All requests for health information/medical records are handled by City of Hope's Health Information Management Services (HIMS) Department Release of Information Team.
 
Please be aware that City of Hope, by law, can only release information that you have specifically requested and authorized on your request form. If no specific direction is given, a Release of Information (ROI) specialist will contact you for clarification. Thank you in advance for your understanding.
 
City of Hope maintains records for both City of Hope National Medical Center (Duarte) and all of City of Hope's community practice sites.
 
Below are the methods by which you or your authorized representatives may request and obtain copies of your health information/medical records.
  • Patient Portal: Patients or their authorized representatives may request their medical records via the patient portal, MyCityofHope. For information on how to enroll in the MyCityofHope portal, refer to the “MyCityofHope” FAQ page on MyCityofHope.org.
  • Walk-Ins: Walk-ins will  only be permitted on the day of your scheduled appointment. NOTE: If you do not have a scheduled appointment, you will not be allowed to enter the facility.
    • Duarte Campus: Located 1500 East Duarte Road, Duarte, CA 91010. HIMS Correspondence office is located near the Social Work Department, Office 1221B. Hours of operation: Monday through Thursday (8am to 4pm), closed for lunch from 12pm to 1pm. Phone: 626-218-2446
      • During closed hours, the day of your scheduled appointment, you may still request your health information/medical records by obtaining and dropping off your completed authorization form at our drop-off box located next to the HIMS correspondence office.
    • Orange County Campus – Lennar Facility: Located 1000 FivePoint, Irvine, CA 92618. HIMS Correspondence office is located on the first floor, within the Radiology Department. Hours of operation: Monday through Friday (8 am to 4:30 pm), closed for lunch from 12pm to 1pm. Phone: 949-671-4275
    • Community practice sites (Completed requests will be routed to our centralized HIMS Department as appropriate).
  • Phone: Requests may be initiated over the phone by calling 626-218-2446. An agent will provide the appropriate forms to complete your request.
  • Fax: Completed authorizations may be faxed over to 626-218-8443.
  • Email: Completed authorizations may be emailed to himsroi@coh.org.
  • Mail: Completed authorizations may be mailed to:

    Health Information Management Services (ROI)
    City of Hope
    1500 East Duarte Road
    Duarte, CA 9101

Authorization Forms To Complete

Please carefully review the following information below to expedite your health information/medical record request. Completed forms may be forwarded to the Health Information Management Services (HIMS) Department following the methods above.
 
Information on Obtaining your Health Information/Medical Records
For you or your authorized representative, describing what to expect and what is generally provided when requesting copies of your health information/medical records — typically for personal use, such as building your personal health record 
  • Information on Obtaining your Health Information/Medical Records Form | English
Authorization to Release or Obtain Health Information/Medical Records
To be completed by you or your authorized representative to obtain copies of your own health information/medical records — OR — to authorize City of Hope to release your health information/medical records to someone other than yourself — usually another facility or provider for the continuity of your care, or for insurance information or state disability forms, etc. — OR — for City of Hope to obtain copies of your health information/medical records from another provider
  • Authorization to Use and Disclose Protected Health Information Form  English | Spanish
Request to Make a Correction to Your Health Information/Medical Records
To be completed by you or your authorized representative if you find an error in your health information/medical records
  • Request for Amendment of Protected Health Information Form | English
Share Your Patient Portal (MyCityofHope) Access with Your Authorized Representative
To be completed by you and your authorized representative (also known as a designated proxy) who would like access to your patient portal (MyCityofHope). From the patient portal, you or your authorized representative can securely and conveniently request your health information/medical records and they will be uploaded onto your patient portal account (or your designated proxy’s account).
Access Your Child’s Patient Portal (MyCityofHope)
To be completed by the patient’s parent or legal guardian who would like access to the patient portal (MyCityofHope). From the patient portal, the patient’s parent or legal guardian can securely and conveniently request health information/medical records and they will be uploaded onto the patient portal.
Who Has Received My Health Information/Medical Records?
To be completed by you or your authorized representative if you would like to request a list (also called an “accounting”) of who has received your health information/medical records. NOTE: Time frames that are requested may not exceed six years and releases made for treatment, payment and health care operations will not be included.
  • Request for an Accounting of Disclosures Form | English


If you have questions about the status of your request after submission, please call our centralized Health Information Management Services (HIMS) Department at 626-218-2446. Please allow five working days to pass before requesting status.

How to submit your disability/medical form(s) to your treating provider

To begin the processing of your disability/medical form(s), all form(s) must be submitted to the Health Information Management Services (HIMS)/Medical Records Department. The HIMS Department will work as the liaison between you and your treating provider. To prevent any delays of the processing of your form(s), please do NOT submit them directly to your treating provider or treating provider care team. Please allow 10 business days for your request to be processed.

If you need resources to help get you through treatment, you can download the Disability Benefits and Financial Resources for Patients and Families brochure for more information. English | Spanish | Chinese

STEP 1

Please ensure all portions of your disability/medical form(s) that require your completion have been filled out prior to submitting them to the HIMS Department.

STEP 2

Forward your completed form(s) to the HIMS Department through one of the methods below:

  • Email: dl-himsmedicalforms@coh.org
  • Fax: 626-218-8443
  • Mail:
    Health Information Management Services (ROI)
    City of Hope
    1500 East Duarte Road
    Duarte, CA 91010
  • Dropoff: The HIMS Office is located in the Geri & Richard Brawerman Ambulatory Care Center, office 1221B, near the lab and Social Work Department. Hours of operation are Monday through Thursday (8 a.m. to 4 p.m.), closed for lunch from noon to 1 p.m.

NOTE: During closed hours, you may still drop off your disability/medical form(s) at our drop-off box located outside the HIMS correspondence office.

STEP 3

The HIMS Department will work with your treating provider for completion.

NOTE: Please allow 10 business days for your request to be processed.

STEP 4

Once your treating provider has completed your disability/medical form(s) request, the HIMS Department will deliver your completed form(s) to the appropriate requester, as well as send a copy to you for your records.

Example of medical form(s) you may need completed

  • EDD - State Disability (Initial)
  • EDD - State Disability (Continuation)
  • EDD - Paid Family Leave
  • Employer - Paid Family Leave
  • Family and Medical Leave Act (FMLA)
  • Social Security "Neoplastic Disease"
  • Medical Certificate of Health Care Provider for Employee's Serious Health Condition
  • Attending Physician Statements (For Insurance)
  • Restriction and Limitation (Employer and School)
  • Authorization (Pre-Authorization for Oral Chemotherapy and Pain Management Medications)
  • Home Health Orders
  • Return to Work
  • Jury Duty
  • Medical Clearance (Dental Work)
  • DMV Handicap
  • Homeland Security
  • Insurance Claim Forms
  • Financial Assistance with Utilities
  • Questionnaires
  • The Leukemia & Lymphoma Society and Cancer-related Retreats
  • BCCTP (Breast & Cervical Cancer Treatment Program)
  • Medi-Cal/Medi-Cal Exemptions Forms