California Civil Code section 56.16 states that the following information may be released:

1. The patient's name, address, age, and sex.
2. A general description of the reason for treatment
3. The general nature of the injury or condition
4. The general condition of the patient,
5. Any information that is not medical information (defined below)

Medical Information is defined in California Civil Code section 56.05 as follows:

"Medical Information" means any individually identifiable information, in electronic or physical form, in possession of or derived from a provider of health care, health care service plan, or contractor regarding a patient's medical history, mental or physical condition, or treatment. "Individually Identifiable" means that the medical information includes or contains any element of personal identifying information sufficient to allow identification of the individual, such as the patient's name, address, electronic mail address, telephone number, or social security number, or other information that, alone or in combination with other publicly available information, reveals the individual's identity.

Thus, any information held by a health care provider, contractor, or health care service plan that falls OUTSIDE the foregoing definition may be released without your authorization if you do not make a written request to the contrary.

If you do not want your non-medical information to be released, per California Civil Code section 56.16, you need to make a written request to the provider that has your information that you do not want any information released about you, whether medical or not.

You can quickly and easily prepare this Request to Maintain Non-Medical Information Confidential by using the .