Records Request
If you are a first-time requester, please download, fill out, and sign any of the following forms.
FORM/ Disclosure of Health Information
FORMA/ Divulgar Información de Salud
Include a copy of a valid Identification Card, and email them to:
request@proactiveworkhealth.com
OR mail them to:
PROCESS CENTER
1142 S. Diamond Bar Blvd PMB 310, Diamond Bar, CA 91765
Your request will not be processed without a signed Authorization release form and a copy of a valid Identification Card.
Frequently Asked Questions
Unfortunately, most healthcare professionals have been forced to deal with attorneys and third party requesters that misuse HHS/OCR guidance on the Patients’ Right to Access rule in order to obtain copies of their clients’ medical records for litigation purposes at the nominal rates allowed under the Privacy Rule. The Right to Access clause does not specify, nor allow patients, attorneys, or third-party requesters to receive an executed Custodian of Records Affidavit —that is only intended for litigation purposes.
To obtain a copy of your protected health information, you will need to fill out our release of information form. Please download a copy from any of the links provided above. The completed form can be fax or email to request@proactiveworkhealth.com.
To download copies of your medical records, you must sign in to your secure online account. If you need help resetting your password, we can help by sending you a link to reset it. Please, click on the following link.
https://proactiveworkhealth.com/forgot-password
Accounts that are inactive, will move to inactive status after ninety 90 days and will not be accessible to the end-user. To resolve this issue, please contact us by email at request@proactiveworkhealth.com
Due to patient confidential and information security issues we do not accept telephone requests. We need a written and signed authorization to release protected health information.
https://proactiveworkhealth.com/account-signup
To expedite the process of your request for records, please sign up by clicking on the above link. As soon as your complete registration is received, we will contact you and provide all the information necessary to retrieve your records.