Medical records
In accordance to the latest public health order from CDPH, only vaccinated individuals will be allowed to visit patients inside the hospital, or individuals that have proof of negative COVID test within 72 hours.
Upon arrival to hospital main entrances, Security or other screening personnel will require all visitors to provide proof of vaccination or documentation of a negative COVID test. Exceptions will be made for end-of-life patients.
Please check our Hospital Visitation Guidelines for more information about our visitation policies.
Emanate Health is committed to protecting your medical information. For information about your rights and the obligations you have regarding the use and disclosure of your medical information, please see our Notice of Privacy Practices.
Fax or Mail in request for medical records
- Download and print the Authorization for Disclosure of Protected Health Information Form.
- Authorization for Disclosure of Protected Health Information (English)
- Authorization for Disclosure of Protected Health Information (Spanish)
- Fax or mail the completed signed form back to us, to the attention of the Health Information Management Office.
Fax:
Mailing Address (for all three hospitals):
Emanate Health Queen of the Valley Hospital
1115 S. Sunset Ave
West Covina, CA 91790
*Please be sure to complete and sign the form before sending.
Only the patient, parent/legal guardian, or the patient's legal health care representative can sign the form to release medical records. If you are requesting records on behalf of the patient or as the patient’s representative, please provide a copy of an Advance Directive/Durable Power of Attorney for Healthcare/Conservatorship.
Unsigned requests cannot be processed and failure to provide all necessary information may invalidate the request.
For assistance and additional information or questions, please contact us during business hours at:626.814.2440
Monday - Friday
8:00am – 5:00pm
Please visit the Patient Health Portal to enroll and access your health information.