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100 W. Second Street Pomona CA 91766-1700 Tel 909 706-3830 Fax 909 706-3785 AUTHORIZATION FOR RELEASE OF STUDENT HEALTH RECORDS It is my understanding that I have the legal right with certain limitations to either view or obtain copies of my protected health information. This right is also granted to the guardian of a minor child conservator of the person psychiatric or non-psychiatric. Further I understand that when deemed advisable by a healthcare provider this right may be denied pursuant...
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Pomona, CA 91766-1700 is a specific zip code within the city of Pomona, California.
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