Request Medical Records

This email is encrypted and HIPAA compliant. Your confidential information pertaining to your request is secure. Oregon law allows us up to 30 days to honor any/all requests for records. Records will be sent electronically to the email address we have on file. Oregon Recovery Behavioral Health is not responsible if our reply is forwarded or redirected to a spam/junk email folder. If you do not have an email, then you will receive records via USPS to the mailing address on file. If you have an expedited request, please call us at (503) 304-4358 and we will make our best effort to honor your request. All requests must be accompanied by a Release of Information (ROI), which we may already have on file. If we do not have an ROI on file, we may reply with a blank form for you to sign and return. This may delay processing time. It is important to state which specific records you are requesting at the time of your request.

"*" indicates required fields

Name of person requesting records

First Name*

Last Name*

Are you requesting records for yourself?*

Yes

Name of entity/agency requesting records (if applicable)

Client Name*

Client Date Of Birth*

Email address to where records should be sent*

Purpose of records request*

Phone

This field is for validation purposes and should be left unchanged.