Authorization for Use or Disclosure of Protected Health Information
Sharp Rees-Stealy provides one year of your health information to physicians outside of Sharp Rees-Stealy for the purpose of continuing care. The one year period consists of documentation from the date of your last Sharp Rees-Stealy visit to 12 months prior, unless your authorization form states a different time period. Please be as specific as possible in identifying the information needed by your new physician.
Download and Complete the Form
Use this link to download and print the form:
Note: For “I hereby authorize,” enter Sharp Rees-Stealy, 4000 Ruffin Road, Suite R, San Diego, CA 92123 and for "Records Released To," enter the name and address of the individual to whom the records will be sent.
You will need Adobe Acrobat Reader to view and download these files.
Please note that Sharp HealthCare does not control or endorse the information presented on external websites, nor do these websites endorse the information found on www.sharp.com.
Return the Form to Sharp Rees-Stealy
Please return your completed form to Sharp Rees-Stealy in one of the following ways:
- Fax it to Sharp Rees-Stealy at 858-636-2424, Attn: ROI Specialist
- Mail it to Sharp Rees-Stealy Central Records Room, Attn: Medical Records, 4000 Ruffin Road, Suite R, San Diego, CA 92123
- Drop it off at any one of the Sharp Rees-Stealy clinics
- Email it to SRS.ROIRequest@sharp.com
Records going to another health care provider will be sent at no charge as a professional courtesy. Records for your own personal use may be subject to a charge based on the quantity of the request.
For More Information
If you have questions about obtaining a copy of your records, please call a Sharp Rees-Stealy Release of Information Specialist at 858-637-6446, between 8 am and 5 pm, Monday through Friday.