Information for Personal Representatives and Third-Party Requesters
If you are requesting medical records on behalf of a patient, Marin Community Clinics requires appropriate authorization and documentation to protect patient privacy.
Personal Representatives
A patient’s legally authorized representative may request medical records by providing:
- A valid photo ID.
- Legal documentation establishing their authority to act on the patient’s behalf, such as a durable power of attorney for healthcare.
- For deceased patients, documentation establishing legal authority, such as proof of appointment as executor or administrator of the estate, and a death certificate, as applicable.
Attorneys, Insurance Companies & Other Requesters
To request medical records, the patient or authorized representative must complete, sign, and date the Authorization for Release of Health Information form.
The authorization must be dated within the past 60 days unless it specifies an expiration date. Incomplete or unsigned requests cannot be processed.
Please indicate whether the records should be mailed to the address provided on the form or picked up at an MCC clinic during business hours.
Additional Authorization for Sensitive Health Information
Certain medical records require specific authorization before they can be released. If your request includes the following information, please initial the appropriate section of the authorization form:
- Mental health treatment records
- HIV/AIDS-related information
