Request a copy of your childs CSOC records

To request the release of a child's protected health information (either a physical or verbal release) from PerformCare, please use the form linked below.
If you are requesting that the information be released directly to you, enter your own information in Section B (Recipient Information) on page 1 of this form.
Please note that this form should be completed in its entirety. You should enter the youth's CYBER ID number where it asks for Member ID.
Incomplete or incorrect forms may delay the fulfillment of the request. If you have questions, you can call Member Services at 1-877-652-7624.
Completed forms should be mailed to the following address:
Consent Processing Center
P.O. Box 7092
London, KY 40742-7092

• Authorization for Sharing Health InformationOpens a new window (PDF)
• Frequently Asked Questions — Authorization for Sharing Health InformationOpens a new window(PDF)
• Autorización para compartir información médicaOpens a new window (PDF)
• Formulario de Autorización de divulgación de información médica: Preguntas frecuentesOpens a new window (PDF)