Request Medical Records

Receive copies of medical records and X-rays

At Placentia-Linda Hospital, you can receive copies of your medical records and X-rays. 

To receive your medical records, download the hospital’s “Authorization to Use and Disclose Health Information” form. You can access it here.

When filling out the form, it is important to follow these directions: 

  1. Fill in the name of the patient as she or he was registered at the time of service at Placentia-Linda Hospital.
  2. Fill in the patient’s phone number, including area code.
  3. Fill in the patient’s date of birth in a month/day/year format. Example: 10/02/2015.
  4. Fill in the complete home address, including house or apartment number, street, city, state and ZIP code.
  5. Specify the date of service and type of records being requested. Example: X-rays taken on 7/01/2015.
  6. Any questions regarding highly confidential information should be directed to the Release of Information officer at (714) 524-4848.
  7. Fill in the name of the recipient with the name of persons or class of persons to whom Placentia-Linda Hospital can disclose your health information. Example: Dr. John Smith.
  8. Fill in the address for the recipient or where your health information should be delivered. Example: Sunnyside Medical Clinic, 1234 West 1st St., Sometown, CA, 92123.  
  9. Fill in the spaces for the term during which your authorization will remain in effect. This should be a date in the future, up to six months from the date of the request. Example:  If you sign the form 01/12/2016, then date this section 06/12/2015.
  10. Married people are not allowed to sign for their spouses unless they have a legal power of attorney and their spouse is incapacitated.
  11. Adult children are not allowed to sign for a parent unless they have a legal power of attorney and the parent is incapacitated.
  12. In general, parents must sign for all minors under the age of 18 years.  

Printed and completed forms can be returned to the Placentia-Linda Hospital Medical Records Department in the following ways:

  • Mail the form to:  Medical Records Department 1301 Rose Drive, Placentia, CA, 92870
  • Bring the form to the Medical Records Department in person
  • Fax both sides of the form to the Medical Records Department at (714) 524-4867 

X-rays and films

To obtain a copy of your X-rays or films, call (714) 524-4846. You must contact the department 24 hours in advance.

When you pick up your films, you will need to print, complete and provide us with the Authorization to Use and Disclose Health Information form. You can:

  • Bring the form to the Medical Records Department in person
  • Fax both sides of the form to Medical Records at (714) 524-4867.