Medical Records

doctor purpleAdventist Health Lodi Memorial takes care to protect the privacy and confidentiality of patients and their medical records. Patients at Lodi Memorial who wish to request copies of medical records or have medical records sent to another party must provide written authorization to the Lodi Memorial Health Information Management Department.

Unless specifically requested or it is an emergency, medical records will be printed and released during regular business hours, Monday through Friday, 8 am-4:30 pm.

Unemancipated minors under 18 must have a parent or legal guardian provide a written authorization for release of medical records.

For medical records of a parent or spouse, that individual must provide written authorization. If the parent or spouse is not able to sign, authorization from a legal representative of the patient may be accepted.

Patient requests for information are generally completed within three to five days from the date of the request. Records will be mailed via certified mail or can be picked up in person at the information desk in the Lodi Memorial Hospital main lobby. To protect patients’ privacy and medical records, identification in the form of a driver’s license or other picture ID is required.

The Lodi Memorial form, “Authorization for Use and/or Disclosure of Patient Health Information,” is provided below:

Authorization for use and/or disclosure of patient health information (English & Spanish)


Print a copy, and complete and sign the form. All sections must be completed in order for the authorization to be accepted. Please provide a current phone number.

Fax the completed form to Health Information Management, (209) 368-3745, or drop the completed authorization off at the information desk in the Adventist Health Lodi Memorial main lobby.

For questions, please contact Health Information Management, (209) 339-7495, and select option one.

For outpatient records from one of the Adventist Health Lodi Memorial Physicians' locations, please contact the specific location for assistance.