Medical Records Request

The Desert Mountain Children’s Center requires a completed authorization form before any medical records are released, and only the following may receive them:

1. A client requesting their behavioral health medical records; or
2. A recognized entity with a legal right to review the contents.

Requests for medical records that are not appropriately signed and/or filled out completely will not be processed. A fee may be applied to a specific request but will be communicated with the requestor prior to charging. Minor children between the ages of 12 and 17 may need to sign their own authorization. A designated staff member will review the records request and determine if the medical record, part of the medical record, or a treatment summary can be released. If you have any questions, please contact our office at (760) 955-3601.

Instructions on How to Complete and Submit the Medical Records Request Form

Note: Clients 12 years and older may need to sign a release of information to process medical records requests.

1. Fill in the Required Information: Complete all necessary fields in the form. Ensure all information provided is accurate and up to date to avoid delays or errors.
2. Save Your Progress: Use the “Save Progress” button (top right of the form) to receive a link via email to resume later.
3. Submit the Form: Verify all required fields are completed and click the “Click to Sign” button at the bottom.
4. Confirm Email Address: You must confirm your email via a link from Adobe Acrobat Sign. The form will not be submitted until this step is completed.
5. Confirmation Receipt: You will receive an email from CAHELP via Adobe Acrobat Sign with a completed PDF of your request. If using the online view, download the PDF for printing.
6. Printing the Form: The form cannot be printed during completion. However, the confirmation email includes a printable PDF version.

If you are experiencing any issues, please contact our office at (760) 955-3601 or email us.