Records Request

The Health Insurance Portability and Accountability Act (HIPAA) requires that health care entities obtain a release to disclose protected health information such as medical records.

An authorization form is available via this link. You will complete the Authorization for Use or Disclosure of Protected Health Information and submit to Medical Records by email, fax, or mail with a copy of a government issued identification.

• For email option, please scan and email your request and a copy of a government issued identification to [email protected]
• For fax option, please scan and fax your request and a copy of a government issued identification to (480) 535-0364.
• For mail option, please print and complete the authorization form. Submit the completed form with a government issued identification to confirm identity. Mailing address: 3133 W. Frye Road, Suite 525, Chandler AZ  85226.

Once required documents are received medical records can be sent electronically via a secure portal, faxed, or hard copy via mail.

Only the patient themselves or their designated "personal representative" (like a legal guardian, parent, or power of attorney) can be authorized to request access to their medical records; other individuals or entities can only access medical records with the patient's written consent or under specific legal circumstances like a court order or for treatment purposes.

If the records are for the patient/guardian and or for continuation of treatment, we do not charge. Fees may apply for other purposes.

The Health Insurance Portability and Accountability Act (HIPAA) requires medical providers to release medical records within 30 calendar days of receiving a request. The 30-day countdown begins when the request is received. If more time is needed, we may grant an extension of up to 30 days. You will be notified of the delay and its reason within the initial 30-day period. Please note if the records request is urgent the compliance team will work to complete the request within 48 hours or two business days.

Clinically relevant pertinent information will be provided that includes, if available, assessments and evaluations, master treatment plan and reviews, progress Notes (clinical, group, psychiatric/medication, nursing, residential), discharge summary, and itemized billing and documentation of charges. If records from a specific visit or treatment are needed, please note in the release form.

Errors in a medical record can be corrected by contacting Embark at [email protected].  An amendment can be requested and an addendum can be added to the medical record.

Request an amendment

1. Review medical records for errors.
2. Contact Embark and request an amendment form.
3. Be clear about what needs to be changed.
4. Provide any supporting evidence.
5. Follow up with to ensure the changes were made.

Add an addendum

1. Write an addendum to be placed in your medical file.
2. Include the new information, sign and date.
3. The original information will not be removed.

The Family Educational Rights and Privacy Act (FERPA) protects the privacy of student education records. The release form allows a parent or eligible student to authorize schools to share their academic records (like transcripts, grades, etc.) with a specified third party such as another educational institution.

An authorization form is available via this link. You will complete the Authorization for Release of Academic Records and submit to Medical Records by email, fax, or mail with a copy of a government issued identification.

• For email option, please scan and email your request and a copy of a government issued identification to [email protected]
• For fax option, please scan and fax your request and a copy of a government issued identification to (480) 535-0364.
• For mail option, please print and complete the authorization form. Submit the completed form with a government issued identification to confirm identity. Mailing address: 3133 W. Frye Road, Suite 525, Chandler AZ  85226.