How to Fill Out CDCR Form 7385: Release of Protected Health Information

To fill out CDCR Form 7385, enter the patient’s full name, date of birth, and CDCR number at the top; name the person or organization who will receive the records; pick which records and date range to release; sign separately next to any sensitive category you want included; set an expiration date; and sign and date the bottom. The form authorizes California Correctional Health Care Services to share medical, dental, or mental health records held on an incarcerated or formerly incarcerated person, and it meets both HIPAA and California’s Confidentiality of Medical Information Act requirements.¹

Where to Get the Blank Form

If the patient is currently in prison, ask for a blank form at the facility’s health care clinic. Anyone outside can download the PDF, in English or Spanish, from cchcs.ca.gov.² You can also request one by calling the Health and Imaging Records Center at (916) 379-4545.³

Patient Information

The top of the form takes the patient’s full legal name (last, first, middle), date of birth, and CDCR number. The CDCR number is what Health Information Management staff use to pull the correct file, so get it exactly right. If the patient has been released, add their current street address and city, state, and zip.² Every entry needs to match what CDCR has on file, and handwriting has to be legible. A form kicked back for clarification adds weeks.

Who Will Receive the Records

Next, identify who gets the records. You can send them to the patient, or to a named third party such as an attorney, outside doctor, or family member. For a third party, write their full name, mailing address, phone number, and relationship to the patient.¹ You can also enter an email address or fax number if you want electronic delivery.² Vague or incomplete recipient information is one of the most common reasons these forms are returned.

Which Records to Release

The form gives three choices, and you pick one:

All information related to the patient’s care, covering medical, dental, and mental health in a single release.
Specific categories, where you check boxes for only the record types you want (medical, dental, or mental health).
Only HIV test results, which are handled separately from everything else.

You also have to write in a “from” and “to” date for the records you want. Leaving the date range blank will likely get the form returned.⁴

Sensitive Categories Need a Separate Signature

Some record types carry extra privacy protections and will not be released on a general authorization alone. For each one you want included, you must sign or initial next to that specific line, with its own date range:

HIV test results. The form has to specifically state HIV results are included, with your signature on that line.¹
Substance use disorder records, including any medication-assisted treatment or Narcotic Treatment Program services.
Mental health treatment records.
Communicable disease records.
Genetic testing records.

Skipping the individual signature for a sensitive category means those records stay back, even if you selected “all information” above.⁴

Purpose and Expiration

State why the records are being released: ongoing medical treatment, a legal proceeding, a disability claim, or at the patient’s request. Under HIPAA, “at the request of the patient” is enough when the patient is the one asking and doesn’t want to say more.⁵

Then pick an expiration. The form offers three options:

Until revoked by the patient.
One year from the date of signature.
A specific date you write in.

If you leave this blank, the authorization expires automatically 12 months after you sign.² California law caps authorization duration at one year.⁶ If you only need the records for a single purpose, set a tighter date or tie expiration to an event, such as “conclusion of litigation.”

Signature

The patient signs and dates the form at the bottom. The signature can serve no purpose other than authorizing this release, as HIPAA and California law both require.⁵ If someone else signs on the patient’s behalf, such as a family member with power of attorney, a court-appointed guardian, or another legal representative, that person must print their name, describe their authority on the form, and attach documentation proving it.¹ Without that proof, the form will be rejected.

Where to Send the Completed Form

The destination depends on whether the patient is still in CDCR custody.

If the Patient Is Currently Incarcerated

Use the in-prison mail system and address the form to “Health Records” at the housing institution. Health Information Management staff there have direct access to the file. Sending it to headquarters or to a different facility only causes rerouting delays.¹

If the Patient Has Been Released or Paroled

Send the form along with a copy of a valid government-issued photo ID to the central records center:³

Mail: Health and Imaging Records Center, P.O. Box 588500, Elk Grove, CA 95758
Fax: (916) 229-0608
Email: releaseofinformation@cdcr.ca.gov
Phone for questions only: (916) 379-4545

The photo ID requirement is the one most people miss. If you mail the form without it, the whole request comes back. Mental health records go through an added step: the authorization is forwarded to a mental health provider for approval before the records are released.

Revoking a Signed Authorization

The patient can cancel the authorization at any time by sending a written notice to the same Health Information Management office that received the original form. Name the specific recipient whose access you want to cut off. The revocation takes effect when the office receives it, but it does not undo any records already shared while the authorization was in force.² After the office processes the revocation, no further disclosures will go out unless a new Form 7385 is signed.¹ For released individuals, send the revocation to the Health and Imaging Records Center at P.O. Box 588500, Elk Grove, CA 95758, or email it to releaseofinformation@cdcr.ca.gov.³

1
California Code of Regulations. Cal. Code Regs. Tit. 15, 3999.217 – Authorization for Release of Information
2
California Correctional Health Care Services. CDCR 7385 Authorization for Release of Protected Health Information
3
California Correctional Health Care Services. Contact Us – CCHCS
4
Department of Corrections and Rehabilitation. CDCR Form 7385 Authorization for Release of Protected Health Information
5
eCFR. 45 CFR 164.508
6
California Legislative Information. California Code CIV 56.11 – Confidentiality of Medical Information