Medical Records

A client, or his/her legal representative, may inspect and/or obtain a copy of their medical records, or have copies of medical records sent to another facility. Clarvida requires a completed and signed Authorization for Use or Disclosure of Health Information form along with the additional required documentation before releasing medical records and/or Protected Health Information (PHI) to anyone, including the client.

How to Request Mental Health and/or Substance Use Disorder Treatment Records:

Please print and complete the Authorization for Use or Disclosure of Health Information form to release records. The form must include the following critical information for processing:

• Client Information
• Healthcare entity name that is authorized to release information (see list above)
• The name and contact information for those authorized to receive records
• Type of records to be released
• Date range of records
• Initial to Authorize Mental Health and/or Substance Use Disorder Treatment Record Disclosures in the appropriate sections on page 2 of the form
• Authorized signature and date
• Forms with any alteration (i.e. crossed out or white out) will not be honored

Additional Documentation Required:

• A photocopy of a government-issued ID for the authorized signing/consenting party
• Proof of the authority to sign for the patient is required for legal representatives and/or guardians

You may deliver the authorization form along with additional required documentation by mail, fax or email.

Mailing Address:

Clarvida Medical Records Department
513 Prince Edward St., Suite 101
Fredericksburg, VA 22401

Fax: (540) 322-3357

Questions? Email MedicalRecords@Clarvida.com

* Please note: For services at locations other than the ones indicated above, please reach out to your local Clarvida office for instructions.  

To find your local office, please follow the link below: 

https://www.clarvida.com/find-a-location/