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Planned Parenthood

Northern California

Medical Records

To have us transfer your medical records to another provider, or for us to get your records from another provider, we need your written authorization. To do this:

  1. Print the appropriate Authorization Form for Release of Health Information.
  2. Complete the form, and sign and date it. Then fax, mail or bring the completed form to one of our Health Centers.

Authorization Forms

Release Health Information to Planned Parenthood 

Release Health Information from Planned Parenthood 

Autorizacion Para La Liberacion De Informacion Medica

Forma De Autorizacion Para La Liberacion De Informacion Medica A Planned Parenthood

 

To view and print our forms you need Adobe Acrobat Reader installed on your computer. To download a free copy of Adobe Acrobat Reader, visit

Adobe’s web site.

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Medical Records