Requesting Medical Records
Patients, or their legal representative, may inspect or obtain copies of their Menlo Medical Clinic (MMC) medical records or have copies sent to another medical facility.
Before MMC allows inspection or provides a copy of a patient’s records to anyone (including the patient or their representative), Menlo Medical Clinic is required under the State of California’s Confidentiality of Medical Information Act to obtain an original, complete and properly executed Authorization for Disclosure of Health Information. You can print the release form by clicking here:
Once you have fully completed the form, you have three ways to get the completed form back to us.
1. In Person. Bring the form to: Medical Records Department
Release of Information Desk
1300 Crane Street, 3rd Floor
Menlo Park, CA 94025
2. By Mail. Please mail to the above address.
3. By Fax. Please fax to (650) 324-9447.
Please allow 10 working days, excluding holidays for processing.
FREQUENTLY ASKED QUESTIONS:
P If someone is to act on the patient’s behalf, a Legal document such as Medical Power of Attorney, Executor of an Estate, Conservator, Legal Guardian, etc. to act on the patient’s behalf are to be presented and a copy is to be placed in that patient’s chart as part of the legal medical record.
P Authorizing individual to pick up copies of your records must be done. Complete the area on the form authorizing someone to pick up your copies. Photo ID must be shown by yourself or an authorized person before we will release copies of your records.
P California Law allows up to 15 consecutive days (10 working days, exclude holidays) from the date the request is received for MMC to copy your records. Please plan your request accordingly. MMC will do everything possible to meet your needs. If you have checked that you wish to pick up your records, please wait for an MMC representative to call you that they are ready.
P Hours: the ROI desk is open: Monday, Tuesday, Wednesday, Friday (except holidays) from 9-11; 2-4; Office is closed Thursday, Saturday, Sunday.
P MMC DOES NOT FAX OR E-MAIL copies of patient’s records unless it is a medical emergency.
P Copies To Be Sent To Another Facility: At times, records have been misplaced when delivered by mail. Please check with the Medical Records Department of the other facility before contacting our ROI desk. If they are not found, please do not hesitate to contact us at 650-498-6166.
P Outside Provider/Facility is being requested to send copies to MMC, you may use our form. Please mail or drop the completed form off at the other facility for processing.
P Avoid delay. Be sure to complete the request in full.
P Copy Charges:
Patient Access: $25 on CD; if requested hard copy/paper copies an add’l 10¢ per page will be charges which includes moving, insurance change, etc. when leaving MMC.
Continued Care: No charge when referred to another provider/facility by a MMC Provider
Method of Payment: Check in the amount only. Medical Records Release of Information DOES NOT ACCEPT cash or credit cards.
Make check payable: Datalink, I.T.S., Inc. which is MMC’s copy service
|