Medical Records
Health Information Management
Your privacy is very important to us. Community Memorial Health Information Management is responsible for securely maintaining and protecting our patients’ medical records. To comply with state and federal law, we may only release a copy of a medical record with proper authorization from the patient or a designated representative.
Obtain or View Your Medical Records
Follow the instructions below to complete and submit your authorization form.
- Select the appropriate form from the list below.
- Download and save the form to your desktop, laptop, or mobile device. If you are attempting to complete your form on a mobile device, you may need to download an additional application (such as Adobe) prior to downloading your authorization form.
- Complete ALL fields on the form. Incomplete forms may result in processing delays.
- Sign the form. Electronic signatures are acceptable.
- Save the form again to ensure your information is captured.
- Submit the form. Please see the "Submit Completed Forms" section below for more information.
Authorization forms:
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Authorization for Use or Disclosure of Health Information
English | Spanish -
Psychotherapy Notes Authorization for Use or Disclosure of Health Information
English | Spanish
Call Your Physician
You may also choose to have your physician fax and request documentation necessary for an appointment ahead of time. This will ensure any necessary reports, results and/or documentation are available at the time of your visit. COVID-19 test results may be obtained by the physician who ordered the test.
Delivery Options
After your completed request has been processed, we will deliver the documents in the requested format and delivery mode. Please be advised that when utilizing email there is some level of risk that your health information could be read or otherwise accessed by a third party while in transit. Please consult the current fee schedule before making your request.
Please call us at 805-948-5047 for assistance with the following:
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Request current fee schedule
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Amend your medical record
We will provide you with a “Request for Amendment of Protected Health Information” form. Complete and sign amendment form and return via mail, fax, or email. Requests take 60 – 90 business days to process. Unsigned or incomplete requests cannot be processed. -
Receive an "Accounting of Disclosures"
We will provide you with an authorization form. Complete and sign this form and return via mail, fax, or email. Requests take 60 – 90 days from the date received. Unsigned or incomplete requests cannot be processed.
Submit Completed Forms
You may submit completed forms in the following ways. To protect your privacy and health information, we do not accept phone requests or disclose patient information over the phone. Please note that attorney, insurance company, and copy service requests MUST be mailed.
Mailed Requests
Community Memorial Hospital - Ventura
Attn: Medical Records/ROI
147 North Brent Street
Ventura, CA 93003
Community Memorial Hospital - Ojai
Attn: Medical Records/ROI
1306 Maricopa Highway
Ojai, CA 93023
Faxed Requests
Community Memorial Hospital - Ventura
805-948-5649
Community Memorial Hospital - Ojai
805-640-1649
Emailed Requests
Email your completed request in a PDF format to ROIrequests@mycmh.org
Contact Information
Phone:
805-948-5047
Hours: Monday – Friday, 8:00 am – 4:00 pm
Closed for the following Holidays:
- New Year’s Day
- Presidents Day
- Memorial Day
- Juneteenth
- Independence Day
- Labor Day
- Thanksgiving Day
- Christmas Day
