Santa Clara Valley Medical Center (SCVMC) fax number

Fax destination details

Department

Health Information Management / Release of Information (ROI)

Purpose

Release of medical records to patients or their authorized representatives; processing requests via the Release of Information form

Form

Release of Medical Record Information Form (Form 9090) — Request for Release of Medical Record Information

Address

751 S Bascom Ave., Room 1C037, San Jose, CA 95128

Voice phone

(408) 885-3764

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Complete the Release of Medical Record Information form, specify which parts of the records you want, indicate patient details and the recipient, sign and date the form. Submit by mail, in person, or by fax to the Release of Information department. Allow up to 10 business days for processing. If someone else will pick up records, provide an original signed authorization letter and a photo ID.