Medical Records: UCI Health — Placentia Linda

Medical Records: UCI Health – Placentia Linda

To receive copies of your medical records and images, you will need to complete an Authorization to Release Information form for Placentia Linda.

Authorization for Release of Health Information form in English
Authorization for Release of Health Information form in Spanish
Authorization for Release of Health Information form in Vietnamese

Forms must be delivered in person with a Photo ID.

Mail or fax the completed forms to: 

Medical Records Department 
UCI Health – Placentia Linda
1301 Rose Drive, Placentia, CA, 92870 

• Direct Phone: 714-524-4846

• Fax Number: 714-524-4867

Birth and death certificates

Birth and death certificates are managed and issued by county health departments. To obtain a copy of a birth or death certificate, contact the health department of the county where the individual was born or died.

Find information about Orange County’s birth and death registration

Request to amend your medical record

Download and print the amendment form to Request to Amend Protected Health Information (PHI).

Request to restrict the use or disclosure of your records

Download and print the Request for Special Restriction of Use or Disclosure of PHI.

Request to opt out of Health Information Exchange

Download and print the Health Information Exchange (HIE) Patient Opt Out form. This form is for patients who do not wish to participate in UCI Health’s national and regional Health Information Exchange (HIE). You may submit by mail or electronically at opoutcareeverywhere@hs.uci.edu.

Requesting medical records at other UCI Health locations 

Procedures for requesting your medical records varies by location: 

• UCI Health – Fountain Valley
• UCI Health – Los Alamitos
• UCI Health – Lakewood
• UCI Health – Orange and UCI Health – Irvine

Patient portals

Looking for login to your patient portal? Learn more about patient portal logins