Medical Records

New patients to El Camino Pediatrics

Request for Transfer of Medical Records
From: Previous Doctor’s Office
To: El Camino Pediatrics

Patients being seen for the first time in our office should provide our physicians with a copy of their child’s medical records. These could be brought in with you on your first visit or requested to be sent to our office.

1. Click to select medical record transfer form pdf
2. Print Form
3. Fill out and mail or deliver to your child’s previous doctor

If you are bringing prior medical records to our office, we will keep them and scan them into our computer system.  If you would like to receive these back, please let us know when you drop them off and when we complete the scanning (give us about 2 weeks), we can let you know they are ready to be picked up.  You can also leave a message for Stacy who is in charge of scanning prior medical records and then she will make sure the medical records are placed downstairs in our patient pick up in our Main Office, Suite B105.  Otherwise, if you indicate that you do not need them back, we will take care of securely shredding these documents.

Original signatures are required, so faxed copies will not suffice.

Other Forms:
Click here to see other forms for New Patients

Existing patients leaving El Camino Pediatrics
OR record requests for other subspecialists

Request for Transfer of Records
From: El Camino Pediatrics
To: Another Facility

There is a $10 fee that is collected along with a release of records form that needs to be signed before we copy records that will be released from El Camino Pediatrics.  There is an additional $5 fee if records need to be mailed. Fee is NOT charged for records being sent for specialty care at the request of our physicians (for example, to see a subspecialist like gastroenterology or ENT).

If you are leaving our practice and want to request us to provide your new physician with a copy of your child’s medical records:

1.  Click to select medical record transfer form pdf
2. Print Form
3. Fill out and drop it off at our office and pay the fee.


Original signatures are required, so faxed copies will not suffice.

If you are seeing a subspecialist who is asking for copies of the records, your child’s primary physician in our office may choose pertinent records to share with the subspecialist, so ask your primary, if you feel this is necessary.