Medical records
To request a copy of your medical record for Emanate Health Queen of the Valley Hospital, Emanate Health Inter-Community Hospital or Emanate Health Foothill Presbyterian Hospital, please follow the instructions below.
How to start a request for a copy of your Medical Record
To start your request, 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)
Next Fax or mail the completed signed form back to us, to the attention of the Health Information Management Office.
FAX:
Inter-Community Hospital and
Queen of the Valley Hospital
626.814.2560
Foothill Presbyterian Hospital
626.857.3287
Mailing Address:
Emanate Health Inter-Community Hospital and
Emanate Health Queen of the Valley Hospital
1115 S. Sunset Ave
West Covina, CA 91790
Emanate Health Foothill Presbyterian Hospital
250 S. Grand Ave
Glendora, CA 91741
*Please be sure to complete and sign the form before sending.
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:
Inter-Community Hospital and Queen of the Valley Hospital
626.814.2440
Monday - Friday
8:00am – 5:00pm
Foothill Presbyterian Hospital
626.857.3250
Monday – Friday
8:00am - 4:00pm
Please visit the Patient Health Portal to enroll and access your health information.