Medical records
Effective August 11, 2021: 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.
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.
Email:
HIM.Medical.Record@emanatehealth.org
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.
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 - Thursday
8:00am – 5:00pm
Please visit the Patient Health Portal to enroll and access your health information.