Request a copy of your childs records
Requesting Copies of Records Youth:
Families have the right to request a copy of their records and PerformCare complies with HIPAA privacy regulations for disclosure of Protected Health Information. A request for records must be submitted in writing to the Quality Improvement department at PerformCare stating what information is being requested and the reason for the request. Release of information requests are processed and mailed to you within 30 days. Youth age 14 and older must consent to the disclosure of records. Families can call PerformCare at 1-877-652-7624 to obtain the Request to Release Information Form.
Families have the right to request a copy of their records and PerformCare complies with HIPAA privacy regulations for disclosure of Protected Health Information. A request for records must be submitted in writing to the Quality Improvement department at PerformCare stating what information is being requested and the reason for the request. Release of information requests are processed and mailed to you within 30 days. Youth age 14 and older must consent to the disclosure of records. Families can call PerformCare at 1-877-652-7624 to obtain the Request to Release Information Form.

performcare_blank_request_for_records.doc | |
File Size: | 31 kb |
File Type: | doc |