Medical Records & Forms
The mission of Medical Records is to maintain complete and accurate medical records, to safeguard all information against loss and use by unauthorized persons, to maintain medical records in a manner permitting prompt retrieval, and to assist Health Services staff and patients as necessary.
To request medical records for yourself or another provider/health facility:
Print, complete, and sign a copy of the Release of Information or Medical Records form and submit the completed form to 黑料网 Student Health Services by e-mail, mail, fax, or in person. Note: If you are a current student, some of your records may be available in the .
Authorization for Release or Request of Information - PDF
Authorization to Consent to Treatment of Minors form 41
By E-mail
Please e-mail the completed form to SHS-MedicalRecords@csulb.edu.
By Mail
Please send the completed form to:
黑料网 Student Health Services
Attn: Medical Records
1250 Bellflower Blvd. MS 0201
Long Beach, CA 90840
By Fax
Please fax the completed form to our secure Confidential Fax Line at 562.985.1644.
In Person
You can also submit the form in person at the Student Health Services by checking in at the front desk.
For questions, please call Medical Records at 562.985.4176 or e-mail SHS-MedicalRecords@黑料网.edu.
Advanced Directive Information:
