Request Treatment Records

Obtaining Treatment Records

To request a copy of a client’s treatment records, please fill out and return the Pioneer Human Services  Authorization to Release Patient Health Information form . You will need to fill out the authorization completely. Failure to complete all required fields may result in a processing delay. 

If you are a person who received treatment at Pioneer Human Services and are requesting your own treatment records:

Under “Provide information to” please print YOUR name in the Name of Facility/Program/Organization, including the address where you want it sent. Also, include a phone number in case there are questions regarding this request. 

If you are an organization requesting Pioneer Human Services records:

Please use your organization’s Authorization to Release Projected Health Information form to make the request, if available. Be sure to include your name, address and phone number. 

If your organization does not have an authorization form, you may use the Pioneer Human Services form.  Please complete all information listed on the form and indicate your organization in the Name of Facility/Program/Organization section.

FOR MORE INFORMATION:

• Notice for Disclosure of Alcohol or Drug Treatment Information (Rules and Regulations by Law)
• PHS Authorization to Release Patient Health Information Policy
• PHS Privacy Practices