Medical Records Request

The Desert Mountain Children’s Center maintains medical records in a secure manner and are released only with a completed authorization form and only to:
  1. A client requesting their behavioral health medical records; or
  2. A recognized entity with a legal right to review the contents.
Consumers may request a copy of their behavioral health medical records with a properly completed records request. Requests 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, and/or a treatment summary can be released. If you have any questions, please contact our office at (760) 955-3601.

Medical Record Request 

Instructions on How to Complete and Submit the Medical Request Form

**A client who is 12 years or older may need to sign a release of information to process this request**

  1. Fill in the Required Information: Complete all necessary fields in the form. Ensure that you provide accurate and up-to-date information to avoid any delays or errors in processing the referral. Make sure the email address for the referring party is correct (page 1). 
  2. Save Your Progress: If you need to save your progress and return to complete the form later, ensure you go to Options on the top left corner under CAHELP and click Save progress. You will be prompted to enter your name and email address. This feature allows you to save your work and resume from where you left off when you revisit the form that will be emailed to you.
  3. Review and Sign: Before submitting the form, carefully review all the information provided to ensure its accuracy. Sign the form electronically using the provided signature field.
  4. Submit the Form: Once you have filled out all the required fields, and provided your electronic signature, and verified the email address is correct, click on the “Click to Sign” button at the bottom of the form.
  5. Confirming Email Address: To ensure accuracy and validity, an email will be sent to the referring party’s email address before the referral form can be completed. You must click on the "Confirm my email address" link provided in the email. The confirmation request will come from Adobe Acrobat Sign. Once you confirm your email address, you will be able to complete and submit the referral form.
  6. Confirmation Receipt: After successfully confirming your signature, you will receive an email from CAHELP via Adobe Acrobat Sign. This email will contain a completed (PDF copy) and printable version of the referral form for your records. If you choose to open the agreement via the link provided, it will take you to a web page of the completed referral. (NOTE: You will have to download the PDF if you choose this function.) There is no need to forward a copy of the confirmation to the DMCC. This copy is for your records.
  7. Printing the Form: Please note that you will not be able to print a copy of the form while completing the document online. However, you can print the completed form from the PDF attached to the confirmation email sent to you.

If you are experiencing any issues, please contact our office at (760) 955-3601 or by e-mail at [email protected].