Learn about the process of making Mental Health and Substance Use Disorder Medical Record Requests.

Release of information

A client or his/her legal representative may inspect and/or obtain a copy of their medical records or have copies sent to another facility.

The Alameda County Health, Behavioral Health Department (ACBHD) requires a completed and signed Release of Information,

Authorization to Disclose Individually Identifiable Health Information form and/or Authorization to Disclose Psychotherapy Notes form before releasing any documents to anyone, including the client.

In certain cases, a client’s clinician, psychologist or social worker may also be required to approve a request made using a release form.

How to Request a Copy of your Alameda County Behavioral Health Care Records

• Print and complete the Alameda County Behavioral Health Authorization to Disclosure Individually Identifiable Health Information form:
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – English
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – English (Large Format)
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Farsi
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Farsi (Large Format)
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Simplified Chinese
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Simplified Chinese (Large Format)
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Traditional Chinese
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Traditional Chinese (Large Format)
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Spanish
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Spanish (Large Format)
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Vietnamese
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Vietnamese (Large Format)
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Tagalog
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Tagalog (Large Format)
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Korean
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Korean (Large Format)
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Arabic
  • ACBH Authorization to Disclosure Individually Identifiable Health Information – Arabic (Large Format)
• Print and complete the Alameda County Behavioral Authorization to Disclosure Psychotherapy Notes form:
  • ACBH Authorization to Disclosure Psychotherapy Notes – English
  • ACBH Authorization to Disclosure Psychotherapy Notes – English (Large Format)
  • ACBH Authorization to Disclosure Psychotherapy Notes – Farsi
  • ACBH Authorization to Disclosure Psychotherapy Notes – Simplified Chinese
  • ACBH Authorization to Disclosure Psychotherapy Notes – Traditional Chinese
  • ACBH Authorization to Disclosure Psychotherapy Notes – Spanish
  • ACBH Authorization to Disclosure Psychotherapy Notes – Vietnamese
  • ACBH Authorization to Disclosure Psychotherapy Notes – Tagalog
  • ACBH Authorization to Disclosure Psychotherapy Notes – Korean
  • ACBH Authorization to Disclosure Psychotherapy Notes – Arabic
• We ask that you specify what components of your medical records you wish to obtain/release.
• All requests must be specifically signed if requesting/authorizing the following information:
• The release forms must be completed in its entirety, dated, and signed.
• If mailing or faxing your request, please provide a copy of a valid government-issued ID along with the Authorization Forms.

If you have any questions about the release of health information from the Alameda County Health, Behavioral Health Department, please call (510) 567-6884. You may deliver your forms in person, via fax, or by mail.

Alameda County Behavioral Health Care
Custodian of Records
2000 Embarcadero, Suite 400
Oakland, CA 94606
Fax Requests To: (510) 777-2208
Hours: Monday – Friday, 8 a.m. – 5 p.m. Closed on holidays.

How to Request a Copy of your Alameda County Substance Use Services Records

If you have any questions about the release of health information from Alameda County Substance Use Services, please call (510) 567-8100.

Contact your SUD treating provider to pick up/deliver or mail/fax your completed release of information authorization forms.

Next Steps After Requesting Medical Records

• Please allow up to 15 calendar days for your request to be processed. If you indicated the option to pick up your medical records, you will be contacted by the ACBHD Custodian of Records Office or the treating clinician’s office when your records are ready. A government photo ID is required.
• If an individual other than the patient is picking up the records, then that individual must have an original signed authorization letter from the patient and a government photo ID.
• Once you have obtained and reviewed your records and you find an error that requires correction, please discuss it with your provider or use the form provided below to request a correction/amendment. Please include a copy of the page(s) where the error(s) occur and the completed form. You will receive a written reply within 60 days but for more complex cases, this may be extended an additional 30 days.

ACBHD & Substance Use Services understands that medical information about you and your health is personal. We are committed to protecting your medical information. This notice will tell you about the ways in which we may use and disclose medical information about you. Please see our Notice of Privacy Practices.

Requests to Amend or Correct Your Records

Once you have obtained and reviewed your records, if you find an error that requires correction, please discuss it with your provider. Requests to amend or correct a record related to substance use disorder and mental health services provided by a non-County Operated agency should be directed to those providers.

Requests for corrections/amendment of mental health records for ACBHD County-operated clinics should be made to ACBHD directly by using the form provided below. Please include a copy of the page(s) where the error(s) occur and the completed form.

You will receive a written response within 60-days. For complex cases, the response may be extended for an additional 30 days.

Request to Amend Protected Health Information Form – English
Request to Amend Protected Health Information Form – Farsi
Request to Amend Protected Health Information Form – Simplified Chinese
Request to Amend Protected Health Information Form – Traditional Chinese
Request to Amend Protected Health Information Form – Spanish
Request to Amend Protected Health Information Form – Vietnamese
Request to Amend Protected Health Information Form – Tagalog
Request to Amend Protected Health Information Form – Korean
Request to Amend Protected Health Information Form – Arabic