Patient Record Requests
Cancer patients can obtain their individual case file data from CCR, as can others with documentation proving they have the legal authorization to obtain this information on behalf of a patient. This includes parents and legal guardians, executors of wills, conservators, those with medical power of attorney, and other relatives (i.e., surviving spouses and children).
Patient Record Request and How to Restrict Use and Disclosure of Personal Information
How to Request Your Patient Records
CCR records can only be released to those who are legally authorized to obtain a patient’s confidential information (i.e., self, surviving spouse, conservator, etc.) CCR requires all patient record requests be made in writing with copy of identification (driver’s license, official state-issued identification card, passport, certified copy of birth certificate, etc.). To request your information please complete CDPH form 6236 (Personal Information). To request access by parent, guardian, or personal representative please complete CDPH form 6237.
Forms must be submitted to:
California Department of Public Health
Office of Legal Services
1415 L Street, Suite 500
Sacramento, CA 95814
To access forms please click on the links below:
- 6236 (Personal Information) (PDF)
- 6237 (Parent, Guardian, or Personal Representative) (PDF)
- Please Note: Do not forget to check Other and add California Cancer Registry in the Directions box on the forms.
If you have any questions, please contact CCR at (916) 731-2500, or by email at CDSRBhelp@cdph.ca.gov
How to Request to Restrict Use and Disclosure of Personal Information
CCR is permitted to release patient contact information to qualified researchers. Some studies require that researchers obtain additional information from individual cancer patients. These researchers may contact patients to find out if they want to participate in a research study. However, patients have the right to refuse to participate in any research study without jeopardizing their current or future medical care.
Your rights.
You do not have to join a research study. Medical care and cancer disease treatment will not be affected if patients do not want to take part in a research study. You may report any concerns about cancer disease research to the Committee for the Protection of Human Subjects (CPHS). If you do not want your information shared with any researchers, you can request to restrict use and disclosure of personal information by completing CDPH forms 6240 or 6241 and submit it to:
Forms must be submitted to:
California Department of Public Health
Office of Legal Services
1415 L Street, Suite 500
Sacramento, CA 95814
To access forms please click on the links below:
- 6240 (Personal Information) (PDF)
- 6241 (Parent, Guardian, or Personal Representative) (PDF)
- Please Note: Do not forget to check Other and add California Cancer Registry in the Directions box on the forms.
If you have any questions, please contact CCR at (916) 731-2500, or by email at CDSRBhelp@cdph.ca.gov.
By law, CCR must obtain cancer data from all patients diagnosed with cancer. For this reason, patients may not “opt out” of reporting. However, all patients have the right to refuse to participate in any particular research study or all research studies. Cancer patients may request that their contact information be withheld from researchers by contacting (916) 731-2500.
For more information on Patient Notification please click here.
For patients who are interested in clinical trials, Information is available from the National Cancer Institute’s Cancer Information Service website or by calling 1-800-4-CANCER (1-800-422-6237).
Additional information, cancer resources, and cancer statistics for patients and caregivers can be found in our About Cancer and Data for the Public sections.
