Health Information Management (HIM) or most commonly known as Medical Records, is a vital component of St​.​ Rose Hospital. The following information will help you get the most out of the HIM Department.

Authorization to Disclose Protected Health Information
If you would like to request a copy of your medical records, please click on the ​button​ below to download the Authorization to Disclose Protected Health Information form, fill in the required information, print and then bring the completed form with you to HIM.

If you would like to fax your completed form, please fax to the HIM Department at (510) 264-4094.

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Download Authorization Form​ - English​
Download Authorization Form​ - Spanish​

You will need Acrobat Reader to view this form.

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​Please contact HIM if you ​require​ any further assistance​:
Medical Record Requests: (510) 264-4039
Medical Record Fax: (510) 264-4094
HIM Director and Privacy Officer: (510) 264-4262

​​Mailing address:
St. Rose Hospital
Attn: HIM
27200 Calaroga Avenue
Hayward, CA 94545-4383