Health Information Management (HIM) is a vital component of the Palo Alto Medical Foundation (PAMF), health care system. We maintain, collect, and analyze patient health information to help PAMF health care professionals such as doctors and nurses provide quality health care.

HIM Contact Information for the Camino Division of the Palo Alto Medical Foundation

HIM Main Phone – 650-934-7979
Health Information Privacy (HIPAA) Hotline – 650-934-7990
Medical Records Release – 408-523-3267
Medical Records Release Fax – 408-524-5034

• Medical Records
• Help with Processing Disability Insurance Requests
• Help with Medical Records for Pediatric Patients
• Pediatric Forms Completion
• Health Information Privacy (HIPAA) Hotline
• Protected Health Information (PHI) Authorization

Medical Records

The Palo Alto Medical Foundation (PAMF) Records Department retains patient medical records for current and future physician reference. Your records are considered confidential and are not disclosed to any outside party without your written authorization.

To ensure the security of your personal health information, PAMF requires patients who need their records transferred to submit a Release of Information request to the Medical Records Patient Service Liaison, located at:

Mountain View Center
701 E. El Camino Real
Floor 2
Mountain View, CA 94040

To have PAMF medical records transferred to a non-PAMF health care provider, please complete:

Authorization for Use or Disclosure of Health Information (PDF)

The release form requires a $15 fee per patient or a $30 fee per family. Make checks payable to ACTA Medical Services.

Send by mail to:

ACTA Medical Services
c/o Palo Alto Medical Foundation
P.O. Box 61538
Sunnyvale, CA 94088-1538

Please include a check for processing your request with your authorization form. To pay by credit card, call ACTA at 408-523-3267.

Your request will be processed and mailed to you in three to five business days. Records will be sent to the requesting patient or health care provider by certified mailed at no extra cost.

There is no processing fee if you would like to have medical records from another health care provider transferred to PAMF. However, PAMF asks that you fill out a:

Request for Access to Medical Information Form (PDF)

Copies of Radiology or Diagnostic Imaging Reports
Release of Information requests can be submitted to the Health Information Management Patient Service Liaison.

Mountain View Center
701 E. El Camino Real
Floor 2
Mountain View, CA 94040

Questions related to the release of Diagnostic Imaging records or images should be referred to the Diagnostic Imaging Services Mail Desk at 650-934-7757.

To obtain digital images on a CD, patients must complete two forms:

For diagnostic images and a release of medical information form

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Help with Processing Disability Insurance Requests

Disability forms are accepted by the HIM Patient Service Liaison (provide link) and processed by the PAMF HIM Disability Specialist. Blank Disability forms can be picked up at the Mountain View Center, listed above, or downloaded from the State of California EDD Web site.
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Help with Medical Records for Pediatric Patients

If a pediatric patient is scheduled for an appointment, the pediatrician or medical assistant will complete the form(s) at no charge.

All other forms will be processed by the HIM Patient Service Liaison. Processed forms will be mailed to the patient’s residence, unless previous arrangements have been made to pick-up the forms in person. Payment for processing can be made by credit card or by check. Cash is not accepted.
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Pediatric Forms Completion

(School Forms, Camp Forms, Sports Forms, Daycare Forms)

Most schools, daycare centers, camps, sports and other organized activities for children require that a child be up-to-date on his or her vaccinations and be in good health. Our pediatric departments can help you fill out the health forms required in most enrollment packages. The following is some information to help guide you through this process.

• Forms may be completed at the well-child check-up at no charge. Other form requests will carry a nominal charge to help us cover the cost of providing this service outside of a medical exam.
  
• Please allow 10 working days for completion of your forms.
  
• When completion of the form requires that the child’s paper medical record be retrieved and reviewed with needed information copied or summarized, a fee of $15 will be charged.
  
• If the form requires information about the child's physical condition (as opposed to a simple record of immunization), a Palo Alto Medical Foundation-Camino Division physician must have examined the child within the past two years.
  
• We can accept forms sent to us by mail or dropped off in person. However, we cannot accept faxed forms.
  
• Completed forms will be mailed to the parent, guardian or designee.

The forms can also be picked up at the Medical Records office located at the Edward Dowd Pavilion, 2nd Floor, of the 701 E. El Camino Real, Mountain View facility. The phone number for this office is 650-934-7981.

• Please pay the cashier or Release of Information coordinator and keep the receipt or form stamped "PAID."
  
• Forms may be mailed, with payment, to:
  Palo Alto Medical Foundation-Camino Division
  ATTN: HIM Medical Records
  701 E. El Camino Real, M/S 31-306
  Mountain View, CA 94040
  
• If you have questions regarding medical records, form completion or release of information, please call the Medical Records office at 650-934-7981.

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Health Information Privacy (HIPAA) Hotline

To discuss concerns about health information protected under the federal Health Information, Portability and Accountability Act (HIPAA) privacy provisions, please call the Health Information Privacy (HIPAA) Hotline at 650-934-7990.

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Protected Health Information (PHI) Authorization

If you would like to view your medical records, get a copy of them or grant authorization for someone else to do the following, then fill out this form:

Request for Access to Medical Information form

and submit it to the Health Information Management (HIM) Department.


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