You may occasionally need to request or authorize sharing your health records to support an insurance or disability claim, legal case, or, most commonly, the smooth continuation of your care between providers.
Key Points
A completed HIPAA Authorization or Release of Information (ROI) form is required to share your protected health information (PHI).
Records requested for personal access require provider review and release approval to ensure only the appropriate information is shared.
If your records request requires the date(s) of service, medical codes, or your provider's signature, the Grow Therapy Records team must assist.
Start your records request
1) Message your provider
Please send a message to your provider through your client portal to start the process. Your message should include the reason for your request and a completed authorization form (included below). They can help determine what information should be authorized for release to meet the specific requirements. Depending on the type of record request, your provider might be able to send you the requested information without any additional steps. However, if certain information is needed, you will need to work with Grow's Records Team to release it.
2) Contact the Records Team
If your request requires records that include dates of service, medical codes, or your provider's signature, the Grow Therapy Records team must prepare them. To start the process, email the details of your request along with a completed authorization form to records@growtherapy.com.
🌟 Note: If you haven't heard back from your provider within one business day and you're unsure whether a Records Team request is needed, feel free to contact the Support Team for help using the Help Widget in your client portal.
Completing the required form
Whether your provider or Grow Therapy is releasing your records, a completed HIPAA authorization form (sometimes called a release of information or ROI form) is required to share your protected health information (PHI). Please complete all sections of the form attached below to ensure timely request processing.
Information on the various sections of the form is outlined below:
Patient information
Patient information
Enter your name, date of birth, email address, and phone number. Be sure to use the email associated with your Grow Therapy account.
Party authorized to disclose
Party authorized to disclose
Grow Therapy is the authorized party to disclose.
If you are only seeking records from treatment with a specific provider, list that provider’s name (optional).
Recipient(s)
Recipient(s)
List yourself as the recipient to obtain a copy of your records for personal use.
If you want your records sent to a third party, such as another provider, an insurance company, or an attorney, list them as the recipient and include their best email address or fax number.
Information to disclose
Information to disclose
Date(s) of Service/date range: Specify which dates will be included in the released records.
Type of records: Check the appropriate boxes to indicate the type(s) of records you authorize for release.
Release purpose
Release purpose
Under "Release purpose," check the box that best applies.
Expiration
Expiration
This authorization is effective immediately and expires one year from the date of signature, unless an alternate expiration date is specified. If you want a different expiration date, write it in the space provided.
Signature
Signature
As this is a legal form, the patient or their authorized representative must sign with either a physical or verifiable electronic signature.
If signed by someone other than the patient, specify the printed name and legal relationship to the patient. Document(s) demonstrating legal authority (i.e., healthcare POA) must be provided along with this form to avoid processing delays.
Submit your request
Submit your record request and completed HIPAA Authorization form to your provider directly via your client portal or to the Grow Therapy Records team via email to records@growtherapy.com. Please allow 30 days for processing time.