Records Request
You may submit or request your medical and Substance Use Disorder (SUD) treatment records at any time through our Health Information Management Department. Please follow the below steps to ensure we can process your request.
Identification (ID) Required for All Requests
All records requests must include a copy of a valid ID to verify your identity.Click here to view the list of acceptable IDsIf you do not have an ID, please contact our office to discuss alternative identity verification.
Requesting Your Personal Medical Records
To request your own records, complete and email the “Request to Inspect/Review and/or Copy a Clinical Record” form to our Records Department.
Sending Your Personal Medical Records to Another Entity
To request your records be sent to another entity, complete and email the “Authorization for Release of Health Information Adapt Integrated Health Care” form with the Request to Inspect/Review form to our Records Department.
- Authorization for Release of Health Information Adapt Integrated Health Care
English | Español - Request to Inspect/Review and/or Copy a Clinical Record
Requesting Substance Use Disorder Treatment Records Request
To request your Substance Use Disorder (SUD) treatment records be sent to another entity, complete and email the “Consent For The Release of Confidential Information” form and “Request to Inspect/Review and/or Copy a Clinical Record” form to our Records Department.
- SUD Consent For The Release of Confidential Information
English - Request to Inspect/Review and/or Copy a Clinical Record
Hours of Operation
Monday – Friday
7:00am – 3:30pm
For after hours or long-distance records requests, please Email, Mail or Fax forms to:
ATTN: Health Information Management Dept.
Adapt Integrated Health Care
621 W. Madrone Street, Suite #223
Roseburg, OR 97470
Fax 844-926-1370
Email: records@adaptoregon.org
If you have questions or need assistance, please contact our office at (541) 464-3929