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Medical Records

Release of Information (DHMF) for the Greater Sacramento Service Area Only

All patients or their legal representatives of Mercy Medical Group (MMG) belonging to Dignity Health Medical Foundation may obtain and/or review a copy of medical records for personal use, or have copies of their medical records send out to their new healthcare provider. Patient requests submitted through this website are for the Dignity Health Medical Foundation-Greater Sacramento Services Area only.

The Health Information Management Department of Dignity Health Medical Foundation requires a completed and signed authorization form to release medical information to another entity, including the patient.

Questions:

If you have any questions regarding release of medical information, please call at (916) 363-4040. Press “0” to connect to our main line and press “1” to connect to a legal/subpoena Associate.

For Hospital Medical Records, Medical Imaging, and Billing records, please contact the numbers below:

 

Release of Medical Information Offices

If you need medical record information from other services areas, please contact the appropriate Release of Medical Information office: 

Bakersfield
9500 Stockdale Hwy, Suite 200–201
Bakersfield, CA 93311
Phone: (661) 327-1431
Fax: 661.321.3286

Bakersfield
3638 San Dimas St.
Bakersfield, CA 93301
Phone: (661) 654-0200
Fax: 916.858.7129

Bay Area
1595 Soquel Dr., Suite 370
Santa Cruz, CA 95065
Phone: (831) 475-7134
Fax: 831.475.1156

Merced
315 Mercy Ave., Suite 400
Merced, CA 95340
Phone: (209) 564-3732
Fax: 916.861.0245

Redding (North State)
2780 Eureka Way
Redding, CA 96001
Phone: (530) 229-0360
Fax: 530.229.0856

Redding (North State)
2526 Sister Mary Columba Dr.
Red Bluff, CA 96080
Phone: (530) 528-6163
Fax: 530.528.6196

Southern CA
550 St. Charles Dr., Suite 200
Thousand Oaks, CA 91360
Phone: (805) 419-7732
Fax: 805.987.2710

Stockton
3132 W. March Ln., Suite 5
Stockton, CA 95219
Phone: (209) 546-5235
Fax: 209.475.5528

Woodland
1207 Fairchild Court
Woodland, CA 95695
Phone: (530) 668-2640
Fax: 530.662.7438

How to Request Records

Patient Request:

If you are requesting records for yourself, please use the Patient Access form:

Download the form

Third Party and Legal Requests: If you are requesting records to be sent to a third party, please use the Authorization of Use and Disclosure form:

Download the form

If you are requesting your Behavioral Health Record, please use the Behavioral Health Release of information form:

Download the form

  • Print, complete and sign the Authorization form.
  • Fax it to: 916-366-3662
  • Or Email completed ROI forms to: [email protected]

(Note: We do not accepted photos of completed authorization forms)

You can also deliver or mail your completed Authorization form to the address below:

Dignity Health Medical Foundation
Health Information Management (ROI Department)
10995 Gold Center Drive, Suite 290, Second Floor
Rancho Cordova, CA 95670

Phone: (916) 363-4040
Fax number: 916-366-3662

Email us your ROI form in a PDF file: [email protected]

Business Hours: Mon. – Friday, 8:00 a.m. – 4:30 p.m. excluding holidays.

Map and Directions

Important Information for Patients to Know

  • A patient can obtain a copy of his/her recent medical record via email. The ROI department can provide a copy of recent (last 2 years) records via email at no charge.
  • The special acknowledgment section must be check marked and signed if requesting/authorizing the following information: AIDS/HIV, Substance abuse treatments, and Fertility Treatment.
  • If you are requesting your Behavioral Health record, please complete and sign the Behavioral Health ROI authorization form.
  • If you select to receive your medical records electronically, a Release of Information staff member will send you a message through Axway MailGate SC, Dignity Health’s secure emailing service. You will be prompted to create a password in which you can then login and view your message containing a PDF file of your medical records. If you need technical help with password setup, please contact our helpdesk at (888) 307-0222.
  • Dignity Health Medical Foundation charges patients $15.00 for more than 20 paper pages, $10.00 for Flash drive, and $15.00 for legal paper record. We only accept checks as a form of payment.
  • No charge applies for recent records (last 2 years) that are emailed to you or to your provider for continuity of patient care.
  • Please indicate the date range that you are requesting, and/or specify which reports are needed.
  • Provide name(s) and the location(s) of your provider(s) on your ROI request.
  • The last two years of a patient’s records are sent to a new physician unless otherwise indicated.
  • Please allow us up to 15 calendar days for your request to be processed. 
  • Patient pick-up is available from our Department location at: 10995 Gold Center Drive, Suite 290, 2nd Floor, Rancho Cordova CA 95670. A valid photo ID is required at the time of pick up.
  • If you find an error that requires correction, please discuss it with your provider or use the form provided below to request a correction/amendment. Please include a copy of the page(s) where the error(s) occur and the completed form. You will receive a written reply within 60-days but for more complex cases, this may be extended an additional 30 days.

Download the form