Health Information Management Services (HIMS/Medical Records) COVID-19 Measures

At City of Hope, your health is our highest priority. We are taking all necessary precautions to protect our patients and staff as the COVID-19 situation continues to evolve, including only allowing patients to pick up their health information/medical records, the day of their scheduled appointment at City of Hope. NOTE: If you do not have a scheduled appointment, you will not be allowed to enter the facility. We understand the importance of providing you with copies of your health information/medical records and will continue to do so in a timely manner.

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: To enroll in our patient portal, refer to MyCityofHope FAQ page for more information.
  • 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.
    • Locations where you may obtain an authorization form and/or drop off your completed form, include:
      • Download and complete our Authorization to Release or Obtain Health Information/Medical Records
      • City of Hope National Medical Center in Duarte, California, HIMS Correspondence office located near the Social Work Department , Office 1221B. Hours of operation: Monday through  Thursday 8 a.m. to 4 p.m., closed for lunch from 12 p.m. to 1 p.m.
        • 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.
      • 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 
 
 
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
 
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
 
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.

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 process your disability forms

 
If you need to apply for State Disability Insurance (SDI), you can apply online at: http://edd.ca.gov/Disability/Disability_Insurance.htm. This is the fastest way to initiate your disability benefits.
 
To learn more about the disability process, refer to http://www.edd.ca.gov/Disability/FAQs.htm.

Alternatively, you can submit a paper form. Please refer to the table below for examples of forms processed.
  • If you are a patient at the Duarte campus, please drop your form off at the Health Information Management Services (HIMS) Correspondence office located near the Social Work Department, Office 1221B.
  • If you are treated at one of our community practice sites, please submit your disability paperwork to your care team at the community practice site.
For any questions, please contact a HIMS Disability representative by email at dl-himsmedicalforms@coh.org.
 
List of forms you may need completed:
 
Processed by Health
Information Management
Services (HIMS)
Processed by physician's office
(Drop off form at HIMS Department)
Processed by financial counselors (Drop off form at HIMS Department)
EDD-State Disability (initial) Jury Duty Medi-Cal
EDD-State Disability (continuation) DMV Handicap
BCCTP (Breast and Cervical Cancer Treatment Program)
Medi-Cal Exemption Forms
EDD-Paid Family Leave Insurance Claim Forms  
Employer-Paid Family Leave Questionnaires (from insurance and legal firm)  
FMLA Restrictions and Limitations (employer and school)  
Social Security "Neoplastic Disease" Return to Work  
Medical Certificate of Health Care Provider for employee's serious health condition Authorizations (pre-authorizations for oral chemotherapy and pain management medications  
Attending physician statements (for insurance) Medical Clearance (dental work)  
  IHSS (In-Home Supportive Services)  
  Homeland Security  
  Financial Assistance with utilities  
  The Leukemia & Lymphoma Society and cancer-related retreats