Requests for Patient Records or Letters

 

 

  • If you would like Central staff to communicate with or send copies of your records to someone outside of the agency, (for example your family doctor, lawyer or probation officer), please complete a Confidential Release of Information form.  Confidential Release of Information Paper  If you would like to view a sample of the completed form, please click the following link. Sample Completed Confidential ROI  Please note that your records may contain information related to mental health, substance abuse, and HIV status.  Please be sure to check all three boxes when completing the release if you would like copies of your clinical assessment, psychiatric evaluation, and/or progress notes to be released. 

Please note that we will attempt to complete your request as quickly as possible, but it may take up to 30 days to process your request.  We appreciate your patience!  If your request is needed by a specific date, please indicate this on the form.  If you have any questions regarding completing any of the forms or the status of your request, please contact the Medical Records Coordinator at 610-277-4600, option one, extension 198, or email medicalrecords@centralbh.org.

 

Please return completed forms to our office at 1100 Powell Street, Norristown, PA 19401.  The completed forms may also be faxed to 610-275-0216 or emailed to medicalrecords@centralbh.org

 

If you have a form that needs to be completed by Central staff, please drop the form off at the front desk at the office location where you attend your appointments.