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Client forms 

All substance abuse treatment records are confidential and protected by federal privacy and security regulations.  With your authorization, a copy of your medical record(s) can be released to you or transferred to another provider.


You have a few options:

  • You may pick up your records at this agency; or

  • You may have them mailed to you; or

  • You may have them sent to a provider you designate (You must provide the name, agency address, phone number, and fax number to the new provider)


Complete, sign, and return the enclosed record release form as soon as possible, but no later than 12/15/23.  Be sure to indicate how you would like to obtain your records.


I will need approximately 14 days to retrieve and prepare the records.


After 12/15/23, you may obtain a copy of your records by mailing a request to PO Box 190736 Anchorage, AK  99519.  All records will be destroyed 7 years from the date of last service.

Blank Release of Information (ROI)

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