Access Your Medical Records

It’s Your Right by Law

California law and Federal HIPAA regulations guarantee access rights to medical records and other protected health information. As a Sansum Clinic patient, you may rightfully access your own health records with but a few limitations. The Clinic provides such access in various ways, although it may be denied in certain specific cases and for legitimate reasons. Patients gain access to their individual records by inspecting them privately in person, by obtaining copies, by receiving a summary report, and by having them forwarded to another provider.

As stored and maintained by Sansum Clinic, health records are accessible in both their paper-based and electronic formats. These records, however, remain the property of the Clinic, and we are obligated to ensure their integrity; to manage and safeguard them in support of services rendered to our patients; and to provide documents pertaining to those services when necessary for continuity of care.

How to Access Your Records

All requests for access are required to be in writing. Telephone or email requests are not valid and are not accepted. To begin the process, obtain a “Request for Access to Protected Health Information” form from the Sansum Clinic Release of Information Department (ROI); fill it out completely; and return to ROI (a) in person, (b) via fax (ROI Fax Number: 805-692-4699), or (c) by mailing the signed and dated form to:

Sansum Clinic
c/o ROI Department
89 S. Patterson Ave.
Santa Barbara, CA 93111

ATTN: HIS Release of Information has moved! Out of the Pueblo basement and into bright and spacious offices at 89 South Patterson, on the corner of Debbie Road and South Patterson (across from Sansum Clinic Goleta Family Practice).

Business Hours:
Monday - Thursday: 9:00 am - 4:00 pm;
Friday: 9:00 am - 12:00 noon

Medical Release Forms

This form, which is also available in Spanish, is necessary for the inspection or copying of a patient’s medical records. Release of patient medical information requires completing an “Authorization for Use/Disclosure of Protected Health Information” form. There is no charge for forwarding health information to other providers including those outside Sansum Clinic.

Sansum Clinic:

Download: Authorization for Use/Disclosure of Protected Health Information (English)
Download: Authorization for Use/Disclosure of Protected Health Information(Español)

Ridley-Tree Cancer Center:

Download: Authorization for Use/Disclosure of Protected Health Information(English)

In you are unable to obtain a copy of the “Request for Access” form, you may also write a brief letter and include the following information:

Date of request and Clinic location visited (e.g. Pueblo Multi-Specialty, Lompoc Multi-Specialty, etc.
Patient’s full name and date of birth
Record type description and time period of documents requested
What kind of access is being requested (e.g. inspection, copies, summary, transmission to another provider)
Signature of requestor (patient or patient representative) and date signed

Types of Access

You may request to inspect your own protected health information in person. Please call (805) 692-6435 and an ROI specialist will assist you as well as guide you during your appointed time.
You may obtain a paper-based copy of your medical record according to your specification. ROI will try to conform with the details of your request but will not provide any guarantee.
Following personal inspection of your health records, should you wish to have copies made, you may ask for them in hardcopy, CD, DVD or other available electronic format. Additional charges may apply for electronic processing.
You may also request that a summary of your visit(s) be provided for certain applicable fees. (Note: Please speak to an ROI specialist for additional information.)
You may ask that copies of certain documents be forwarded to another provider outside the Clinic. There is usually no charge for this ROI service.

If You Choose Inspection

Private personal inspection of your medical record is cost-free but requires supervision. With a confirmed appointment having been made in advance, a Sansum Clinic staff member (typically an ROI specialist) will assist you through the review process. Monday through Thursday hours of inspection are generally between 9 a.m. to 12 p.m. and 1 p.m. to 4 p.m. Friday hours are between 9 a.m. and 12 p.m. With an advance written request, you may be able to arrange for a one-hour inspection at other times.

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If You Would Like a Copy

If you initially requested personal inspection of your records and then decided later that you need copies of what you viewed, you must submit a new request. Copies will be available within 15 days of receipt of this follow-up request. (Please speak to an ROI specialist regarding delivery timeframes and other options.)

MRIs, Scans, Tracings, Mammograms, & Other Records

Besides releases of protected health information, the ROI Department also accepts and processes requests for access to radiological images and digitized medical records. Personal inspection of x-ray films, scans, tracings, and mammograms are handled in the Radiology Department. A standard fee of $10.00 is charged per film and associated reports. Patients requesting the release of mammograms receive originals with copies thereof being retained in the medical record. (Note: The duplication charge for a copy of an x-ray image comes from the copy service and is billed directly to the patient.)

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You Choose to Obtain a Summary Report

Patients and patient representatives may request a “Summary Report” in lieu of obtaining copies or viewing records in person. Such a report is typically prepared by the primary care physician (PCP) with charges being billed the patient for the cost of the preparation. The report is normally provided within 10 working days unless the report is unusually lengthy, in which case you will be notified. The maximum allowable time for furnishing the summary is 30 days, unless an extension is arranged with the requestor. In circumstances where there is a complicated file, the provider may reduce the record’s findings to a simplified form, that is, in lay terms rather than in clinical jargon.

If You’re Moving or Changing Providers

If moving to another area is the reason for your request or if the services you are seeking are being provided by a non-Sansum physician (i.e. outside Sansum Clinic), simply ask your outside doctor to place an official request for your medical record. Upon receipt of the request, courtesy copies covering the last two years of your Clinic visits will be forwarded directly to the requesting physician at no cost to you.

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Denial of Access: When the Request is for a Minor’s Record

The parent, conservator, or guardian of a minor patient is ordinarily entitled to request a summary report, inspect the patient’s protected health information, or obtain copies of the medical record. However, there are three exceptions by which such access would be denied, namely:

The minor patient has the individual right to consent to treatment. (Typical case examples are emancipated minors; married minors; prevention or care of pregnancy; patients involved with substance abuse, or certain communicable diseases.)
When Sansum Clinic determines that release or disclosure of records may have a detrimental effect on its relationship with the minor patient.
When Sansum Clinic determines that release or disclosure may have a detrimental effect on the minor patient’s physical safety or psychological well-being.

Denial of Access: Psychiatric Records

Sansum Clinic may deny the patient direct personal inspection or obtaining complete copies of his or her mental health or psychiatric records if it is determined that there is a substantial risk of significant adverse or detrimental consequences to the patient in accessing such records. But if denied, the patient has the right to designate a licensed physician, a psychologist, or clinical social worker to inspect the record and receive copies or summary report. A written authorization from the patient or patient representative must be submitted to the ROI Department prior to any record release to the designated recipient.

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