Medical Records Requests
- Client, Legal Guardian, or Legal Representative may request records online, onsite or by downloading and printing the Client Access to PHI form and then send to medical records.
- Diversus Health does not accept requests by telephone.
- Client Access to PHI forms are available in both English and Spanish.
- Diversus Health recommend requesting a limited set of records. Requests for complete records can delay processing.
- Processing medical record requests can take up to 15-30 days from date of receipt.
- Records will be released and delivered to you in the method you select on the Client Access to PHI form.
- Photo ID (government issued or school ID) is required to request medical records.
- There is no charge for a copy of your medical records.
- Legal Representative must provide paperwork showing that they are permitted to request records on the client’s behalf. Paperwork may be uploaded when submitting the Client Access to PHI form online. It may also be emailed, faxed, mailed or provided onsite.
- Diversus Health may deny access to all our part of my request if it is believed there is a potential risk to the client or someone else.
Medical Records request for minors:
- Diversus Health requires client’s signature if the client is 15 years of age or older and you are requesting behavioral health or psychiatric care information.
Request your medical records online or in person.
To request records in person at one of our locations, stop by the front desk to complete the Client Access to Personal Health Information (PHI) form on paper. To make an online request or download request forms, see the links below.
FOR CLIENTS REQUESTING MEDICAL RECORDS
ONLINE – Complete forms online
Client Access to PHI – English
Client Access to PHI – Spanish
PDFS – Download, print, complete, sign, and return to us by email, mail, fax, or in person.
Client Access to PHI – English PDF
Client Access to PHI – Spanish PDF
CONTACT US
Contact us if you would like to verify that we have received your medical records request, to get the status of your request or for any other questions.
Business Hours: Monday-Friday: 8:00am to 5:00pm
Phone: 719-572-6100, option 4
Fax: 719-314-4257
Email: medicalrecords@diversushealth.org
Mail: PO Box 15318, Colorado Springs, CO 80935
FOR OUTSIDE AGENCY RELEASE OF INFORMATION FORMS
For agencies or individuals that are not the client, legal guardian or representative.
ONLINE – Complete forms online
Release of Information – English
Release of Information – Spanish
Online Request for Medical Records | This form is to be used when :
- Diversus Health has a release of information on file for you or your agency.
- Client has signed your agency’s release of information. Please note: If the client has signed your agency’s release of information, you will be asked to upload it.
PDFS – Download, print, complete, sign, and return to us by email, mail, fax, or in person.
Release of Information – English PDF
Release of Information – Spanish PDF
Download Request for Medical Records | This form is to be used when :
- Diversus Health has a release of information on file for you or your agency.
- Client has signed your agency’s release of information. Please note: If the client has signed your agency’s release of information, you will be asked to upload it.
If you are unsure whether Diversus Health has a release of information on file for you to your organization, please call us 719-572-6100, option 4 or email medicalrecords@diversushealth.org