In some situations, you may want to review or need to authorize L.A. Care to release your Protected Health Information ("PHI"). In these situations you will need to fill out the form below.
Request to Inspect, Copy, and Release PHI - English
Request to Inspect, Copy, and Release PHI - Spanish
Request to Inspect, Copy, and Release PHI - Chinese
Request to Inspect, Copy, and Release PHI - Korean
Request to Inspect, Copy, and Release PHI - Armenian
Request to Inspect, Copy, and Release PHI - Russian
Request to Inspect, Copy, and Release PHI - Tagalog
Request to Inspect, Copy, and Release PHI - Vietnamese