The paperwork you encounter while at the hospital may seem overwhelming. Certainly, the paperwork involved in hospital care is immense! But the paperwork is an important part of care -- it is essential for our staff in every area to document accurate information that will help us provide the best service to you.
To help you prepare for your visit, we are presenting certain forms on-line. Feel free to print these forms, read them carefully, complete them and bring them with you when you come to the hospital.
All of the forms below are saved as Adobe Acrobat files to retain the format of the form. If you do not have Acrobat Reader, you can obtain a free copy of it from the Adobe Website using the link below.
Download Adobe Reader
Advance Healthcare Directives
The Advance Health Care Directive is a legal document that allows you to appoint someone to speak on your behalf in the event of a medical emergency. The Institute for Healthcare Advancement's website has this form available for free downloading in multiple languages.
Your Medical Records
You have a right to access your medical records, and to have your records (or a portion of your records) released to another party. The forms below begin the process.
- Request for Release of Health Information
This is known as the "General Authorization for Use or Disclosure of Protected Health Information." Please print this form, complete it and deliver it in person to Medical Records Department located on the second floor of the Medical Office Building. Please be sure to bring a valid photo ID.
Eden Medical Center: Request for Release of Health Information (PDF, 209 KB)
- Request for Access to Medical Records
Please fill out this form, print and sign it, and mail it to Medical Records Department, 20103 Lake Chabot Road, Castro Valley CA 94546, or fax it to (510) 888-9198.
Eden Medical Center: Request for Access to Medical Records (PDF, 245 KB)
Eden Medical Center will provide access for inspection during business hours within 5 working days of receiving the request. Staff will provide copies within 10 working days of receiving the request and any applicable fees. There are certain limitations in specific cases, so please feel free to contact us at any time if you have a question. Learn more about your rights to access health information.
You can access a pre-registration form in English or Spanish, or you can use our secure, on-line registration process.
Notice of Privacy Practices
Learm how medical information about you may be used and disclosed by Eden Medical Center and how you can access this information.