What are medical records?
“Medical Records” are defined as clinical, medical, or therapeutic documentation relating to a client which is maintained by Evolve Treatment Centers, also known as Protected Health Information (PHI).
What is Evolve’s medical records policy?
Evolve strives to maintain the highest level of client confidentiality and HIPAA standards.
To request medical records, a release of information authorization form (ROI) must be completed and submitted to Evolve’s Medical Record Department. The ROI must be completed in accordance with state and federal regulations.
The following components should be included:
- Client’s full legal name and birthdate
- Contact information for recipient of written records
- Purpose of disclosure
- Client signature
How do I request Medical Records from Evolve?
For Evolve to be able to release any records, a signed authorization form must be complted and signed. Mental health and substance abuse treatment records are highly confidential and protected by law due to the sensitive nature of the information contained within them. We are unable to release that information without explicit permission in writing. Completing the following ROI form correctly and completely according to the guidelines outlined on this page is the first step in the process of reqesting records.
Step 1:
Complete the following form in its entirety:
The form must be completed according the guidelines below for it to be processed.
An incomplete form will delay the process.
The more specific the request, the faster the records will be produced. Please check the specific items you want released and be sure to explain the purpose of this record request so we can best assist you.
Step 2:
Complete the e-Signature process.
Once completing the form above, you will receive an electronic version to be signed by all required parties.
Step 3:
Print out the form and have the minor sign the form. It is important the minor’s signature is handwritten.
The minor client’s signature should be included on the release of information form.
You will receive a 4-digit request ID, use that ID to return the completed form to us here.
After submitting the completed form to Evolve’s Medical Records Department, the request will be processed. It may take up to 10 business days for the records to be sent via fax, encrypted email, or if preferred, through certified mail.
The Medical Records Department will do its best to send out the records as soon as possible. If there are mitigating circumstances, please inform the Medical Records Department so they can do their best to meet those specific needs.
Step 4:
Submit the completed and signed ROI to us.
Once you have printed the completed form and obtained the minor’s signature, please upload a digital image of the ROI using the the 4-digit request ID that you received upon completing the form electronically in our system.
Use that 4-digit ID to return the completed form to us by clicking here.
Please be in touch with any questions. Thank you!
Email: medicalrecords@evolvetreatment.com
Phone: (424) 502-0803
Fax: (424) 285-8154
Evolve Medical Records Department