Medical Records and Billing Information
To receive copies of your medical record or billing information, you must
submit a written, signed, and dated request form. You may download, print
and complete the Authorization for Use or Disclosure of Health Information
in English or
Mail or fax your completed request to:
St. Jude Medical Center
Health Information Services
101 E. Valencia Mesa Drive
Fullerton, CA 92835
Phone (714) 992-3940
Fax (714) 992-3098
You have the option of receiving your information on a thumb drive or paper
copies, please indicate your preference on the authorization form. Most
requests are completed within 3 – 5 business days of receipt of
the authorization. In some instances, requests may require additional
time to process.
When picking up your copies you will be required to show photo identification.
Medical records/billing information may be released to anyone that the
patient authorizes in writing to receive such information. A valid authorization
MUST contain the following information:
- Patient’s full name
- Date of birth
- Specific information to be released (i.e. lab report) and the date of service
- Purpose for which the information may be disclosed (continuing care, insurance,
disability, personal use)
- To whom the information is to be sent to including the name and address
or who will pick up the information
- Specify when the authorization will expire
- Identify if you would like a copy of the authorization
- The patient’s signature or a patient’s legal representative’s
signature. Authorizations signed by a representative must include a copy
of the durable power of attorney, guardianship etc.
- Date of the signature
Information pertaining to mental health treatment, HIV and alcohol and
drug are designated as sensitive information. In order to release this
information, the authorization must specifically state this. There are
check boxes on the authorization that should be checked and initialed
if this information is requested.
There may be a fee associated with the production of your medical record/billing
information. St. Jude Medical Center utilizes BACTES Imaging Solutions.
If you have questions regarding the fee, please contact BACTES at (714)
992-3000, ext. 3676.
If you have any questions regarding obtaining copies of medical records/billing
information please contact Health Information Services at (714) 992-3940.