Records Request

In order to release records, a signed authorization for the release of protected health information is required. For minors, a parent or guardian signature is required. For youth ages 18 and older, and youth who are minors but have a substance use disorder diagnosis, the youth’s signature is required. The type and purpose of the information to be shared must be initialed.

Download Release of Information Form

Fax all Releases of Information with a list of the specific documents requested to the attention of Quality Assurance at 866.223.0888.