Custodian of Records

Custodian of Records

Phone: (714) 834-3536
Fax: (714) 835-9312
Mail: HCA / Custodian of Records
P.O. Box 355
Santa Ana, CA 92702
Hand Deliver: Office of Custodian of Records
200 W. Santa Ana Blvd., Suite #125
Santa Ana, CA 92701
Please note that our public entrance is on Sycamore.
Hours of Operation: Monday - Friday
8:00am - 5:00pm
Observed Holidays: New Years Day                        Memorial Day                Veteran's Day
Martin Luther King, Jr. Day      Independence Day        Thanksgiving Day &
Lincoln's Birthday                     Labor Day                      Friday after Thanksgiving
President's Day                        Columbus Day               Christmas Day

Find format and accessibility information when you read about downloading files.

Requesting Medical Records — Protected Health Information (PHI)

Any time a patient is treated by the Health Care Agency, a medical record is made. Your medical record is protected under State and Federal confidentiality laws including HIPAA. The Custodian of Records office oversees all requests for medical records maintained by the Health Care Agency. For more information please visit the County of Orange HIPAA web site.

When you receive immunizations at a Health Care Agency clinic, you are given a copy of your "shot card" to keep. If you need to request an additional copy of your immunization information, you can return to the Immunization Clinic and request an additional copy and complete an authorization form at the clinic or complete the "Authorization to Use and Disclose Protected Health Information form on this page.

The Custodian of Records office oversees all requests for medical records maintained by the Health Care Agency. A copy of your medical record can be released to you or someone you identify in a signed patient authorization (a third party). Use the “Authorization to Use and Disclose Protected Health Information” form below to request a copy of your medical record, COMPLETE all required information and SIGN.

The following authorization form meets HIPAA regulations and can be used to request records. The usual turnaround time is 7-10 days to process the request for copies of medical records. Some fees may apply.

Medical Records Authorization








Authorization to Use and Disclose Protected Health Information (PHI)
This authorization form is for: County of Orange clients to request a copy of their own medical information or to request that their medical information be released to another health care provider. Third parties such as client representatives or attorney’s requesting medical information.
PHI Form in PDF (Vietnamese) PHI Form in Word (Vietnamese)

PHI Form in PDF (English) PHI Form in Word (Farsi)

PHI Form in PDF (Farsi) PHI Form in Word (Farsi)

PHI Form in PDF (Korean) PHI Form in Word (Korean)

PHI Form in PDF (Spanish) PHI Form in Word (Spanish)

PHI Form in PDF (Vietnamese) PHI Form in Word (Vietnamese)

Additional Forms regarding Medical Records






Revocation of Authorization to Use or Disclose Protected Health Information - Instructions available in Word or PDF format.  Revocation of Authorization Form in PDF
Request for Special Restriction on the Use or Disclosure of PHI - to request restrictions on the release of their medical information.
Termination of Special Restriction - to communicate and document cancellation of restrictions on medical.
Request for Restriction on the Manner/Method of Confidential Communications – to request special arrangements for communication of their medical information, such as using a cell phone or work phone instead of a home phone.
Request to Amend PHI - to request an amendment to their medical information.
Request for an Accounting of Disclosures - to request an accounting of medical disclosures that the client might not otherwise be aware of, such as reporting a communicable disease.

Access To Public Records

The California Public Records Act requires public agencies to provide access to public records held by Health Care Agency (HCA). Requests may be made for records regarding inspections, investigations, evaluations, statistical data, policies, reports, etc. Certain information, such as names of complainants, personal medical information, and records regarding ongoing litigation will not be released pursuant to the California Public Records Act and various privacy rules.

Requests for HCA public records (except for Environmental Health records) are handled through the Custodian of Record office. Please see the link below to request Environmental Health records. To assist you in locating your records please provide as much information as possible about the request including business name and address.

Records Request
Title Description View
Public Records Request
  • Statistics
  • Studies
  • Policies and Procedures

Click here for public records request
Environmental Health
  • Health Inspections
  • Plumbing problem complaint
  • Food poisoning complaint
  • Water Quality
  • Medical Waste

Click here for Environmental Health records request
Hazardous Waste/Underground Tanks
  • Hazardous Waste Generators
  • Underground Storage Tanks
  • Solid Waste
  • Proposition 65 Reports
  • Certified Unified Program Agency (CUPA)

Click here for Hazardous records request

Subpoenas for Health Care Agency (HCA) Records 

Subpoenas for HCA records or court appearances must be personally served. The release of records or disclosure of client information will be subject to existing federal, state, and county regulations. Each subpoena will be evaluated according to the type of request, the program or service provided to the client, and whether or not the records are confidential, in which case they will not be released.

Fees for Production of Subpoenaed Records

The production of records pursuant to a subpoena requires an advance minimum payment of $15.00, however, a reasonable cost may also apply, such as: payment of fifteen cents ($0.15) per page for photocopying; twenty cents ($0.20) per page for copying from microfilm; actual postage; clerical costs for locating and making records available not to exceed twenty-four dollars ($24) per hour, calculated to the nearest quarter hour, or any actual costs charged by any third person for retrieval/return of records.

Court Appearance

An advance deposit fee of $275 per day is required at the time of service of a civil subpoena for appearance at a trial or hearing. A demand for payment for the full amount will be billed to the requesting party after the testimony is complete.