Request Your Medical Records

Request a Copy of Your Medical Records from Freedom House

INSTRUCTIONS

How to Request Your Medical Records

Medical records may include assessments, treatment plans, progress notes, medication lists, and treatment history. You might need a copy for a new provider, ongoing care, or your personal records. To request your records, you must provide a valid consent form signed by you for the release of information. Freedom House will provide your medical record within 30 days of receiving your valid consent form.

On-Line Requests

Electronic Request for Your Medical Records

You can get your medical records electronically by completing our form. Submit the completed form to Freedom House via email or fax. We will send your medical records with a secure fax to your email upon completion. 

Authorization Form in English

Authorization Form in Spanish

 

Requests may be submitted electronically via email or fax:

Third-Party

Attorneys, legal representatives, and other authorized parties may request records by submitting either: a signed and dated patient authorization, or a valid court order signed by a judge specifying the exact records requested.

Requests may be submitted by mail, fax, or email:

For questions or unique circumstances regarding court orders:

Electronic Health Information Exchange (HIE)

We may participate in certain Health Information Exchanges (HIEs) that allow healthcare providers and other entities, such as your health plan or health insurer, to share your health information for treatment, payment, and other purposes permitted by law, including those outlined in this Notice of Privacy Practices. Currently, we are active participants in these HIEs.

Interpreter Services

Freedom House Recovery Center provides a variety of free language assistance services for patients who prefer to communicate in a language other than English. For more information about the available interpreter services, please inquire at Freedom House Recovery Center.