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Health Information Management

Riverside San Bernardino County Indian Health, Inc.

In accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Riverside-San Bernardino County Indian Health, Inc. is required to make available a Notice of Privacy Practices. This notice describes how your health care information may be used and disclosed by Riverside-San Bernardino County Indian Health, Inc. during the ordinary course of its business and how you can get access to this information. Please review it carefully. If you have any questions, please contact Quality Management/Compliance Officer, Compliance Hotline 866.640.3532.

Riverside-San Bernardino County Indian Health Inc. provides several options to obtain your health records. You may obtain your medical records at

any of our locations by fax, mail, or in-person.

Morongo / Torres Martinez Fax Number (951) 849-0457

San Manuel / Barstow Fax Number (909) 907-7930

Soboba Fax Number (951) 487-2449

Pechanga/Cahuilla Fax Number (909) 503-1143

Patient Portal Access and Information

Health Information Portability Accountability Act (HIPAA) Authorization Information

Notice: The HIPAA Authorization Form is a document required by California State and Federal Law that allows us to release records to your designated recipient. This authorization form must be completed fully and accurately. Your request will be delayed if any of the below patient information is missing:

– Patients’ Full Name & Date of Birth

– The Recipient to Whom the Records Will Be Released (Name & Address)

– The Purpose for the Release (e.g., Continuity of Care, Legal Matter, Personal Use)

– The Specific Health Information to be Released

– From specific Date: through End Date

– Disclosure Format

– The Expiration Date OF The Authorization Form

– Signature of the Patient or Legal Representative (if patient is a minor)

– A copy of your Photo ID, and/or, Supporting Legal Documentation for the patients’ representative. (e.g., Legal Guardianship, Advance Healthcare Directive/Power of Attorney, Designation of Personal Representative)

Riverside San Bernardino County Indian Health Inc. provides several options to obtain your health records. You may obtain your records via: the patient portal, encrypted email, USPS mail, or in-person.

Medical Records Forms

How To Contact The Medical Records Department

San Manuel & Barstow Indian Health Clinic

11980 Mount Vernon Ave Grand Terrace, CA 92313

Phone: 909.864.1097 HIM eFax: 909.907.7930 email:

Morongo & Torres Martinez Indian Health Clinic

11555 ½ Potrero Road Banning, CA 92220

Phone 951.849.4761 HIM eFax: 951. 849.0457 email:

Soboba & Santa Rosa Indian Health Clinic

23119 Soboba Road San Jacinto, CA 92583

Phone: 951.654.0803 HIM eFax: 951.487.2449 email:

Pechanga & Cahuilla Indian Health Clinic

47001 Pala Rd Temecula, CA 92592

Phone: 951.676.6810 HIM eFax: 909.503.1143 email: