IF YOU ARE REQUESTING RECORDS FOR VISITS DATED JUNE 27, 2022 OR LATER:
- Complete the Authorization for Release of Health Information form with the complete address & fax number of the new provider you wish to send the records to. The release must authorize UCSF Nancy Friend Pritzker Psychiatry to release the information being requested.
- If the patient is a minor ages 12-17, the minor must sign & date the release in order for it to be valid (per California's Confidentiality and Minor Consent law)
OR
- If new provider has their own release, the provider can fax the release to Attn: Pritzker Psychiatry HIMS at (415) 502-6361 or email it to [email protected]
IF YOU ARE REQUESTING RECORDS FOR VISITS PRIOR TO JUNE 27, 2022:
- Please contact Langley Porter Psychiatric Hospital at (415) 476-7221 or [email protected] for their release of information form. Records from Langley Porter are maintained by a separate Medical Records team and are not considered part of Pritzker Psychiatry.