Records Request
Requesting your medical and/or substance use treatment records from our Health Information Management Department (HIM) can help.
ATTN: Health Information Management Dept.
Adapt Integrated Health Care
621 W. Madrone Street
Suite 223
Roseburg, OR 97470
Phone
Fax
Verify Your Identity
- All requests need a valid ID. You can find a list of acceptable IDs here.
- If you don’t have an ID, contact our office for other identity verification methods.
Request Personal Medical Records
- Fill out the Request to Inspect/Review and/or Copy a Clinical Record Form
- Email the completed Form to records@adaptoregon.org.
Transfer Records to Another Entity
- If you want your records sent to another place, fill out both:
- Release of Health Information
English | Español - Request to Inspect/Review and/or Copy a Clinical Record
- Release of Health Information
- Email the completed Forms to records@adaptoregon.org.
Request SUD Treatment Records
- To send your SUD treatment records to another entity, fill out both:
- Release of Health Information
English | Español - Request to Inspect/Review and/or Copy a Clinical Record
- Release of Health Information
- Email the completed Forms to records@adaptoregon.org.