Medical records

• 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)*
• Fax or mail the completed signed form back to us, to the attention of the Health Information Management Office.
• Mailing Address (for all three hospitals):
  Emanate Health Queen of the Valley Hospital
  1115 S. Sunset Ave
  West Covina, CA 91790
• Fax: 626.814.2560

• Records for service: 9/1/2013 through 08/31/2022
  Please use Authorization for Disclosure form and follow directions above
• Records for service: 9/1/2022 and later
  Please contact the Glendora Surgery Center directly
  Phone: 626.610.1850

Effective 12/5/24

• If you are a patient requesting a copy of your own medical records, a legal guardian or a patient representative with a power of attorney, please visit the Patient Medical Records Request page.
• You are also able to obtain a copy of radiology/imaging CD and report done at Emanate Health Imaging at any of our hospitals’ Radiology/Imaging department nearest you.
  • Inter-Community Hospital - 210 W. San Bernardino Road Covina, CA 91723
  • Foothill Presbyterian Hospital - 250 S. Grand Ave Glendora, CA 91741
  • Queen of the Valley Hospital – 1115 S. Sunset Ave West Covina, CA 91790
  • Radiology/Imaging department hours for CD request: Mon-Fri, 9 a.m. - 2 p.m.
• 3rd Party Request for Medical Records:
  All Copy Services must serve subpoenas for radiology CD and reports to the address below. We cannot accept a subpoena by fax.
• SHARECARE
  2461 E. Orangethorpe Ave. Suite 102, Fullerton, CA 92831
  Office hours: Mon-Fri 8:00 a.m. - 4:00 p.m. Lunch 12:30 p.m. - 1 p.m.
  Phone 877.777.7882
• Non-subpoena requests may be faxed to 866.476.0415 or upload your request.
• Please contact the Health Information Management department at 626.814.2440 for questions or assistance.