Medical Records Request

Medical Records

If you have questions about obtaining medical records for yourself or a third party, please contact us by clicking the button below.

Request Your Medical Records

You, a parent, legal guardian or personal representative can request access to your medical records. 

To request a copy of your medical records, download the form (available in both English and Spanish), read the information provided, then follow the instructions on how to submit the form titled: Request for Access to Protected Health Information.

The form must be completed and signed for us to process your request.

Click Here to download the form in English.

Haga clic aquí para descargar la forma en Español.

 

Authorization to Release Medical Records to a Third Party

To release copies of medical records to third party entities such as hospitals, primary care providers, attorneys etc., download the form Authorization to Release Confidential and Protected Health Information. 

The authorization form must be legible, complete and signed to release mental health records to third party entities.  The completed form can be faxed to 303-504-6504 or emailed to HISM_DL@mhcd.org   

Click Here to download the form in English.

Haga clic aquí para descargar la forma en Español.

Pay For Your Records

Once we receive your request and approve it, you will receive an invoice for the cost of processing your request. To pay for records by credit card, use the Invoice Number located in the upper right corner on The Mental Health Center of Denver Health Information Systems Management INVOICE. Input the total price listed on your invoice, then click "Continue."

After you click "Continue," you will be directed to a secure payment page. Once you have finished processing payment for your records, you will be given the option to redirect back to this page. 

MHCD-Dickenson A/R Order Form
Quantity Invoice Number Price
1
 

Contact Us

Address: 

Mental Health Center of Denver

Health Information Systems Management

4141 E Dickenson Place

Denver, Colorado 80222

Phone: 303-504-6510

Fax: 303-504-6504

Email: HISM_DL@mhcd.org   

Hours: Monday to Friday, 8am to 5pm