Enthusiastic Sobriety Records Request Email Template

Copy, paste, and complete this records request letter to the program’s email address and include an attachment of your photo ID confirming your identity.

info@thepathwayprogram.com

info@theinsightprogram.com

info@thecornerstoneprogram.com (Colorado)

info@thecrossroadsprogram.com

info@fullcircleprogram.com

RECOVERY@CSTEAMCOUNSELING.COM - (Texas)

Disclaimer: Medical record retention laws by the state may vary. Records are typically destroyed 7 - 10 years after discharge from OP.


Hello:

I am writing to request that you provide all physical and digital copies of my records from my time in the [PROGRAM NAME] from [ESTIMATED INTAKE DATE] to [ESTIMATED DISCHARGE DATE] that are in your custody or possession. My name is [NAME] and my date of birth is [DOB].

Please email me at [YOUR EMAIL] my complete treatment record/chart for me relative to my treatment at [PROGRAM NAME] for all dates of treatment of service specified below and all materials or information, including, but not limited to:

All entry paperwork, assessments, treatment plans, treatment notes, interoffice memos, milieu staffs’ records, consultation records, any correspondence with other professionals, exit paperwork and any other materials (whether written or stored, created or maintained in any other form) relating or pertaining to me, including documents and records received from or that were created by another provider.

Here is my address for a physical copy: [YOUR CURRENT ADDRESS]

Attached is a photo of my ID confirming my identity. [INSERT OR ATTACH PHOTO ID]

The Law

Under the Health Information Technology for Economic and Clinical Health Act (“HITECH Act”), health care providers are required to provide every patient a copy of their electronic health records, in a format of their choice. Significantly, the HITECH Act preempts state law.

The HITECH Act provides that the individual making the request for protected health information (“PHI”) can designate a third-party to receive the information, i.e., an attorney.

The individual is able to choose the method of production of PHI under the Act, and the regulations state it can be in paper or electronic form.

The personal health information requested by an individual must be provided in the form requested by the individual, including in a readable electronic form if the covered entity uses electronic health records. This can be a .PDF, compact disc, or as commented by the Department of Health & Human Services, via email if the individual is warned of the security risk associated with unencrypted email.

Deadline for Responding

Aside from some exceptions, a covered entity must act on the request no later than thirty (30) days from the receipt of the request by: (1) providing the requested information, or (2) providing the individual with written denial of the information.

If you are unable to comply with the thirty (30) day deadline for providing the requested medical records, we ask that you contact us in writing before the deadline expires. In your letter, you must provide a written statement of the reasons for the delay and the date by which you will provide the medical records. Under the HITECH Act, you are only provided one such extension of time.

Penalties for Non-Compliance with the Act

There are substantial monetary fines and penalties for failing to comply with the HITECH Act. The Office of Civil Rights of the Department of Health and Human Services can investigate complaints and levy fines for violation of the Act. If a healthcare provider is found to have “willfully neglected” a provision or provisions of the Act, the Office of Civil Rights of the Department of Health and Human Services will impose mandatory fines of up to $250,000 and up to $1.5 million for repeat or uncorrected violations.

If you do not use electronic medical records, please contact me within ten (10) business days of your receipt of this communication in order to make alternative arrangements for the production of the medical records.

Thank you in advance for your cooperation.

[YOUR NAME]


FAQs About Records Requests