Your Rights
Notice of Privacy Practices
How medical and drug and alcohol related information about you may be used and disclosed and how you can get access to this information.
Non-Discrimination
It is the policy of Adapt Integrated Health Care that our employees treat all clients in a non-discriminatory manner. Our staff will not discriminate against any client or patient on the basis of race, religion, color, age, sex (including pregnancy), national origin, veteran status, disability, marital status, genetic information, sexual orientation, gender identity or any other classification protected by applicable federal, state or local laws.
Clients & patients will not be discriminated against for inability to pay or because payment for these services will be made by Medicaid or Medicare. In addition, Adapt does not tolerate harassment of any client or patient on those bases.
Clients & patients with disabilities will be afforded all the rights and protections of the ADA. Adapt does not create or enforce any policy or procedure that may interfere with that right. Adapt employees follow policies and procedures that comply with the ADA and must notify a supervisor if a procedure seems to interfere with those rights.
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.