United States Department of Veterans Affairs
United States Department of Veterans Affairs

VA Loma Linda Healthcare System

Release of Information

Our Release of Information staff will be happy to assist you with requests for your medical records. We also assist providers with completing forms for patients.

We can assist you with the following —

  • access to your medical records
  • obtaining copies of your medical records
  • requests to amend your medical records
  • completion of forms for benefits, insurance, and other reasons

The Release of Information Staff is expert in our patients' rights and their medical records.

The Release of Information Office is located in building 10.  They can be reached at (909) 825-7084 ext 6031.

How to Request Information

To request a medical record, please one of the forms listed in the column to the right, complete the requested information, sign the form, and mail it to the following address —

Loma Linda VA Healthcare System
Release of Information
11201 Benton Street
Loma Linda, CA 92357

Because forms must contain an original signature, e-mailed forms cannot be accepted.

Requests for records will take approximately 10-14 days to process.

Fees

There is no cost to send copies directly to another health care provider. If copies are for a patient's personal use, photocopying fees may be assessed.


Patient Information

Eligibility
Make, Change or Cancel and Appointment
Advance Directives
Patient Education
Customer Service
Discharge
Billing and Insurance
Release of Information

Related Links

VA Healthcare Eligibility
Notice of Privacy Practices

Release of Information Forms

pdf document

Request for and Authorization to Release Medical Records or Health Information (VA 10-5345)

pdf document

Individuals' Request for a Copy of Their Own Health Information (VA 10-5345a)