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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 “Record Holder’s Name,”enter Sharp Rees-Stealy, 2001 Fourth Ave., San Diego, CA 92101 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:
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.
I believe excellent health is an essential ingredient to happiness, which is life's ultimate goal."
1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm.
If you have any additional questions,
send us an email using our secure contact form.
Sharp HealthCare is San Diego's health care leader with 7 hospitals and 2,600 affiliated doctors.
Sharp is not-for-profit and relies on fundraising. © 2013 Sharp HealthCare. All rights reserved.