Overview
CHE Behavioral Health Services processes requests for medical records and other authorized disclosures of protected health information (PHI), including:
- Patient medical records requests
- Requests from authorized personal representatives
- Healthcare provider requests
- Insurance and payor requests
- Attorney requests
- Court orders and subpoenas
- Audit, accreditation, and regulatory requests
- Other legally authorized disclosures
How to Submit a Request
Please submit all requests and supporting documentation to:
Important: Standard email is not an encrypted or HIPAA-secure channel. Please do not include sensitive protected health information (PHI) — such as diagnoses, treatment details, or full Social Security numbers — in the body of an email. Send completed authorization forms and supporting documents as password-protected attachments, by fax, or by postal mail when possible. By emailing us, you acknowledge the inherent risks of unencrypted email.
For information on how CHE uses and protects your PHI, see our Notice of Privacy Practices.
To avoid delays in processing, please include any required documentation, such as:
- HIPAA authorization forms
- Proof of authority or legal representation
- Subpoenas or court orders
- Other applicable supporting documentation
Requests are reviewed and processed in accordance with applicable federal and state privacy laws.
Required: Release of Information (ROI) Authorization Form
A completed Release of Information (ROI) Authorization form is required before any medical records can be released. Please download, complete, and sign the form, then submit it with your request.
CHE ROI Authorization Form (2026)
PDF · Complete, sign, and submit with your request.