Your records are maintained by our hospital’s Medical Records Department with utmost care. If you need a copy of your record for personal use, there is a nominal charge. We will be happy to copy your record for any physician who is to provide continued medical care for your well-being, at no charge.
To request your medical records, please contact Medical Records department.
Phone number to call: 909-625-8363.
Hours of operation: Monday – Thursday 9:00 am to 4:00 pm and Friday 9:00 – 12:00 pm.
*Hours are subject to change without notice.
We are closed on evenings, weekends and holidays.
How do I request a copy of my health information?
To request a copy of your/your child’s health information, an authorization must be completed and signed, directing and authorizing us to release your information. The form may be either ours, or from the facility requesting information, but must be specific to the release of protected health information and the associated required guidelines, or it may be rejected.
You may submit the request in person from Monday – Thursday 9:00 am to 4:00 pm and Friday 9:00 – 12:00 pm, or by mail to:
Montclair Hospital Medical Center
5000 San Bernardino St
Montclair, CA 91763
Attn: Medical Records/ROI
You may also fax the request to: 833-714-0351 or 909-625-8283
You can also call Release of Information for additional information regarding obtaining copies: 909-625-8363
Who is authorized to sign for release of my protected health information?
- The following people are authorized to sign for release of protected health information:
- The patient (not the patient’s spouse or a parent of a patient).
- The parent or legal guardian, if the patient is younger than 18 years of age. (Proof of legal guardianship may be required.)
- A guardian, if the patient is legally judged incompetent. (Proof of legal guardianship may be required.)
- Emancipated minor (the minor is legally married, is a parent, is pregnant, or has been legally emancipated by the court).
When will I receive a copy of my medical record?
Copies are processed within 14 business days from the date the request is received by Montclair Hospital Medical Center.
How much does it cost to obtain a copy of my health information?
- There is no charge for releasing copies of health information directly to other healthcare providers. (The records must be sent directly to the healthcare providers’ address.)
- $15 clerical/retrieval/processing/mailing fee. Record copies will not be released until payment received. (The $15 clerical fee, payable to MHMC.)