You may submit a request for any of the following records in accordance with applicable public records laws. The departments have included a direct link to some of the records; if there is no link for the record you are seeking, and/or you would like to request additional information regarding that record, please contact the department or division directly using the contact information provided for that specific record.
Admission Referral
Category:
Clinical Records
Remarks:
Administrative Policy
Division:
Retention Type:
2 - Current
Retained On-Site:
2 Years
Application For 72-HoUR Detention
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
2 - Current
Retained On-Site:
2 Years
Bed Committee Referral Form
Category:
Clinical Records
Remarks:
Administrative Policy
Division:
Retention Type:
2 - Current
Retained On-Site:
2 Years
Casarc Records
Category:
Clinical Records
Remarks:
22 CCR
Division:
Retention Type:
2 - Current, 3 - Storage
Retained On-Site:
7 Years
Retained Off-Site:
7 Years
Certification Review Hearing Record
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
1 - Permanent
Retained On-Site:
Indefinitely
Child/Family Intake From Inpatient Hospitalization
Category:
Clinical Records
Remarks:
Administrative Policy
Division:
Retention Type:
2 - Current
Retained On-Site:
4 Years
Communicable Disease Reports to State and Local Health Departments
Category:
Public Health Records Reportable
Remarks:
22 Cal. Code Regs. S70735. Retention period unspecified
Division:
Retention Type:
1 - Permanent
Completed Statement Form (Sfpd)
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
2 - Current
Retained On-Site:
2 Years
Controlled Drug Form
Category:
Clinical Records
Remarks:
Administrative Policy
Division:
Retention Type:
2 - Current
Retained On-Site:
3 Years
Crisis Bed Referral Form and Service Plan
Category:
Clinical Records
Remarks:
Administrative Policy
Division:
Retention Type:
2 - Current
Retained On-Site:
5 Years
Critical Incident Reporting:Clinical/Non-Clinical
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
1 - Permanent, 3 - Storage
Retained On-Site:
7 Years
Retained Off-Site:
Indefinitely
Denial of Rights/Seclusion and Restraint Quarterly Report
Category:
Public Health Records Reportable
Remarks:
State Mandate
Division:
Retention Type:
1 - Permanent
Retained On-Site:
Indefinitely
Dms Emergency Response Record
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
2 - Current
Retained On-Site:
2 Years
Flu Vaccine Request Form
Category:
Clinical Records
Remarks:
Legal Ret. Dept. Policy
Division:
Retention Type:
2 - Current
Retained On-Site:
1 Year
Geriatric Servicesinpatient Referral Form
Category:
Clinical Records
Remarks:
Administrative Policy
Division:
Retention Type:
2 - Current
Retained On-Site:
4 Years
Guidelines For Information Sharing With Police
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
2 - Current
Retained On-Site:
5 Years
Initial Contact Card
Category:
Clinical Records
Remarks:
Administrative Policy
Division:
Retention Type:
2 - Current
Retained On-Site:
7 Years
Injuries Related Tocriminal Conduct/Reportingrequirement For Health Practitioners
Category:
Public Health Records Reportable
Remarks:
Penal Code §11160, et. Seq., as amended by Assembly Bill 1652
Division:
Retention Type:
1 - Permanent
Retained On-Site:
Indefinitely
Inpatient Medical Records Including Pes and Imds
Category:
Clinical Records
Remarks:
22 CCR §70751, 75731, 75055 Administrative policy
Division:
Retention Type:
2 - Current
Retained On-Site:
Retained for period set by individual hospital policy, not less than 7 years
Monthly Reporting Involuntary Detentions
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
1 - Permanent
Retained On-Site:
Indefinitely
Official Record of Patient Denied Statutory Rights
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
2 - Current
Retained On-Site:
2 Years
Patient Clinical Records Including X-Rays Films or Reproduction (Persons 18 and Older)
Category:
Clinical Records
Remarks:
Administrative Manual Policy 3.10-7, Division of Mental Health, Substance Abuse and Forensic Services, 5-14-93; Title 22, Div. 5 §70751, 75731, 75055
Division:
Retention Type:
2 - Current
Retained On-Site:
7 years
Patient Clinical Records of Unemancipated Minors
Category:
Clinical Records
Remarks:
22 CCR §70751, 75731, 75055
Division:
Retention Type:
2 - Current
Retained On-Site:
7 years
Patient Clinical Records Retained For Research/Tracking
Category:
Clinical Records
Remarks:
22 CCR § 70751, 75731, 75055 UCSF affiliation agreement
Division:
Retention Type:
2 - Current
Retained On-Site:
7 years
Retained Off-Site:
UCSF
Patient's Rights Denials-Monthly Tally
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
2 - Current
Retained On-Site:
2 Years
Prescriptions-Mia Triplicate Ones and Regular Pads
Category:
Clinical Records
Remarks:
Legal Ret. Dept. Policy
Division:
Retention Type:
2 - Current
Retained On-Site:
3 Years
Psychology Autopsyreport
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
1 - Permanent, 3 - Storage
Retained On-Site:
7 Years
Retained Off-Site:
Indefinitely
Release From Hospital Ama
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
2 - Current
Retained On-Site:
4 Years
Report of Suspected Adult/Elder Abuse
Category:
Public Health Records Reportable
Remarks:
CA W&I Code, Chapter 11, §15630 and 15633, SB1691 (Chapter 594 of 1994)
Division:
Retention Type:
1 - Permanent
Retained On-Site:
Indefinitely
Report to Superior Court Patient Requirement
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
2 - Current
Retained On-Site:
4 Years
Sf Mental Health Provider Ab3632/Non-Ab3632 Day Treatment Regulation Referral Form
Category:
Clinical Records
Remarks:
Administrative Policy
Division:
Retention Type:
2 - Current
Retained On-Site:
4 Years
Statement Acknowledging Requirement to Report Suspected Physical Abuse of Elder/Adult
Category:
Public Health Records Reportable
Remarks:
CA W&I Code, Chapter 11, §15630 and 15633, SB1691 (Chapter 594 of 1994)
Division:
Retention Type:
1 - Permanent
Retained On-Site:
Indefinitely
Tar Forms For Dms and Medi-Cal
Category:
Clinical Records
Remarks:
Administrative Policy
Division:
Retention Type:
2 - Current
Retained On-Site:
7 Years
Treatment Profile For Child/Adolescent
Category:
Clinical Records
Remarks:
Administrative Policy
Division:
Retention Type:
2 - Current
Retained On-Site:
7 Years
Voter Registration
Category:
Public Health Records Reportable
Remarks:
Administrative Decision
Division:
Retention Type:
2 - Current
Retained On-Site:
1 Year