In compliance with patient confidentiality and privacy laws, health information may not be released without a patient’s written authorization. To request medical records, you must submit an Authorization for Release of Health Information and/or Mental Health Authorization of Health Information online via My Student Chart.

Patient Portal

• • • Log in to the My Student Chart.
    • Click Upload Images/Clearance Forms
    • Find “Patient Authorization to Release Medical or Mental health Information” to download the form then upload, when completed.

In-Person, Fax, E-Mail or Mail

• If you are a non-student, previous student, outside medical facility, another healthcare provider, attorney, insurance company, or any other party, please download, print, complete and sign an Authorization for Release of Health Information.
• Submit the form via fax, mail, e-mail or in-person:
  • FAX:  949-824-3033
• E-MAIL: SHC-MEDICAL-RECORDS@UCI.EDU
• IN-PERSON or by MAIL: ​​​ 501 Student Health, Irvine, CA 92697-5200​​​Please note that it is Student Health Center and University policy, in accordance with CDC guidelines, that all HIV test results are reported to the recipient in person before the records may be released via phone, mail, or fax.
• If a lab test or x-ray is ordered by an outside provider (i.e., a non-SHC provider) and the test is performed at Student Health Center’s Clinical Lab or Radiology department, the results are sent immediately to the outside ordering provider. Requests for copies of these lab results or x-ray studies should be made directly to the respective department:
  Clinical Lab: (949) 824-6361 | Radiology: (949) 824-5812

Medical Record Processing Time
All requests for copies of medical records are processed in the order that they are received. Most requests for active records are completed within 15 business days of receipt.

A reasonable, cost-based fee may apply. Applicable fees must be paid in advance before records are released.

Copies of medical records will be sent to another healthcare provider free of charge.

A fee of $15 will be charged for requests from attorneys, insurance carriers or other third parties

Current fees for processing medical records release requests:

• Medical Records: duplication fee per page              $0.25
  (There is no charge for the first 10 pages, maximum charge of $16.00.)
• Medical Records: duplication fee for Subpoena      $15.00
• Attorneys/Insurance Carriers/3rd Party Request    $15.00
• Medical Records: USB                                                   $5.00
• Medical Records will notify you of any processing fees.
• Methods of Payment: Payment in the form of  check or credit card is accepted and can be made at the Cashier’s Window in the lobby of SHC. If mailing a check, please include your name, student ID# and indicate that payment is for a medical records request.  If paying by telephone using a credit card, please call the SHC Cashier at (949) 824-7084. Copies of records will not be released nor will records from off-site storage be requested until payment has been received and confirmed.

New students, prior to their initial appointment at the Student Health Center (SHC), must acknowledge that they have read and understand SHC’s Notice of Privacy Practices. You may acknowledge this policy at the time of appointment self check-in at SHC or on the Wellness, Health & Counseling Services secure Student Health Patient Portal.

UC Statement of Privacy Practices – General Data Protection Regulation (GDPR) – UC SHIP

The General Data Protection Regulation (“GDPR”) standardizes data protection law across all 28 European Union (EU) countries and imposes strict new rules on controlling and processing personally identifiable information (PII). It also extends the protection of personal data and data protection rights by giving control back to EU residents. GDPR replaces the 1995 EU Data Protection Directive, and goes into force on May 25, 2018. It also supersedes the 1998 UK Data Protection Act. The University of California, as part of its ongoing commitment to protecting your privacy, has published a document (see below) that provides relevant information to registered students who are located in the European Economic Area (“EEA”) regarding how the University of California Student Health Insurance Plan (“UC SHIP”) collects and processes the information that you share.