Health Records Request

Health Records

Information About Requesting Health Records

If you are the person in services requesting copies of your own health records, or a personal representative (as defined in HIPAA) requesting copies of health records, for yourself – please read information about an “Access Request” below:

Access Request

Create an online portal account or download the WellPower app. For more information, please go to: www.wellpower.org/wellpower-app.

AND/OR

Submit a written request by:

1. Download & submit a hard copy: Complete and hand sign the “Request for Access to Health Information” form. It can be downloaded online at wellpower.org/health-records. Submit the completed form to the HISM team by email, fax, postal mail, or in-person (contact information provided below). A readable copy of the requestor’s valid government-issued photo ID must be included to verify signature.

OR

2. Complete & submit an electronic copy: Complete and e-sign the “Request for Access to Health Information” form online using docusign. You can do this by going to www.wellpower.org/health-records or by contacting the HISM team to complete over the phone. A readable copy of the requestor’s valid government-issued photo ID must be included to verify signature.

Once we receive the completed form, we may reach out to you to confirm your request, with any questions, and/or to coordinate any next steps.

If you are the person in services, or personal representative (as defined in HIPAA) requesting copies of health records to be sent to someone else, or someone else requesting copies for yourself – please read information about a “Third-Party Request” below:

Third Party Request

Submit a written request by:

1. (This is the most common option) The third-party directly submits a written request for the information to HISM with a valid signed “Authorization to Release Confidential & Protected Health Information.”

OR

2. Download & submit a hard copy: Complete and hand sign the “Authorization to Release Confidential and Protected Health Information” form. It can also be downloaded online at wellpower.org/health-records. Submit the completed form to the HISM team by email, fax, postal mail, or in-person (contact information provided below). A readable copy of the requestor’s valid government-issued photo ID must be included to verify signature.

OR

3. Complete & submit an electronic copy: Complete and e-sign the “Authorization to Release Confidential and Protected Health Information” form online using docusign. You can do this by going to wellpower.org/health-records or contacting the HISM team to complete over the phone. A readable copy of the requestor’s valid government-issued photo ID must be included to verify signature.

Once we receive the completed form, we may reach out to you to confirm your request, with any questions, and/or to coordinate any next steps.

Who can sign off on a request for health records?

The individual who is the subject of the health information or their “personal representative,” if applicable.

A “personal representative” is anyone who has legal authority to make decisions about the individual’s healthcare, including rights to access the health record. This could be a parent or parents (for unemancipated minors) who maintain(s) medical decision-making authority, a court-appointed legal guardian, someone with healthcare power of attorney, etc.

As applicable, supporting documentation must be included with the request, such as birth certificate, court order signed by the judge, or healthcare power of attorney.

How long does it take?

All requests will be reviewed by the Health Information Systems Management (“HISM”) team. Requests can take up to thirty (30) calendar days to complete. If a request is time sensitive, it is important to give ample time for a request to be completed. How much time is needed depends on the nature of the request, the number of requests already in queue, any need for additional documentation or information, and occasionally due to staffing.

In what form and format can I receive the health information?

  • Electronic copy (PDF file)* sent via secure email or e-fax.
  • Electronic copy (PDF file)* on CD sent via certified postal mail or picked up.
  • Electronic copy (PDF file)* on USB drive sent via certified postal mail or picked up.
  • Printed hard copies sent via postal mail or picked up.
  • Viewing (for access requests only) - a time and date can be arranged to view the health records in person at our Dickenson location or through a virtual meeting.

*Electronic copies are in PDF format and require PDF reader software to view.

Are there fees for the request?

If fees are applied, an invoice will be provided with the total and instructions on how to make payment. WellPower is a non-profit organization focused on the well-being and service of the Greater Denver area. The fees applied to your request help continue to support those services to the community.

Access Request

Viewing: No fee
PDF copies by email: $6.50 flat fee
PDF copies on CD or USB drive & picked up: $6.50 flat fee
PDF copies on CD or USB drive & by postal mail: $6.50 + postage
Printed hard copies: Fee is calculated based on cost of materials, never to exceed $25. Additional fees for postage costs and/or notary certified copies.

No fees for:

  • Administrative paperwork
  • Summary of services reports
  • Medication list
  • Lab testing results
  • Diagnosis information
  • (Neuro)psychological assessment report

**other exceptions may apply

Third Party Request

Fees are applied per Colorado state regulations and are to be paid for by the third-party. Additional fees for postage costs and/or notary certified copies.

No fees for requests:

  • To other healthcare providers
  • To probation or parole departments / courts
  • To department of human services
  • To grant awardees of Laura Hershey Disability Act (“LHA”)
  • By court order or search warrant

**other exceptions may apply

Can the request be declined?

Yes, see below:

Access Request

The request is reviewed by designated licensed health professionals who determine whether the health information requested will be released in-whole, in-part, or entirely declined. State and federal statutes outline specific conditions for granting or denying access to health information.

If the request has been denied in part or in full, the requestor will be notified. If the denial is eligible for an appeal, the requestor can initiate a request for a denial review. Information on how to submit an appeal will be included with the denial notification.

Third Party Request

Only what is permitted and/or authorized for release and is the minimum needed to fulfill the purpose of the request.

Submit a Health Records Request

Access Request

A written request must be submitted to the HISM team. There are two options on how to do this:

1. Download the form: Complete and hand sign the “Request for Access to Health Information” form.

Submit the completed form to the HISM team by email, fax, postal mail, online document upload or in-person (contact information provided below). A readable copy of the requestor’s valid government-issued ID must be included to verify signature.

OR

Complete online: Complete and e-sign the “Request for Access to Health Information” form online using docusign here:

Third-Party Request

A written request must be submitted to the HISM team. There are three options on how to do this:

1. The third-party directly submits a written request for the information to HISM (this is the most common option).

OR

2. Download the form: Complete and hand sign the “Authorization to Release Protected Health Information” form.

Submit the completed form to the HISM team by email, fax, postal mail, online document upload or in-person (contact information provided below). A readable copy of the requestor’s valid government-issued ID must be included to verify signature.

OR

3. Complete online: Complete and e-sign the “Authorization to Release Protected Health Information” form online using docusign here:

Once we receive the completed form, we may reach out to you to confirm your request, with any questions, and/or to coordinate any next steps.

Make a Payment

If a fee is applied to your request, an invoice with instructions on how to make payment will be provided. Please follow the instructions on the invoice or call us with any questions.

Contact Us

Health Information Systems Management

Address: 4141 East Dickenson Place, Office #170, Denver, Colorado 80222
Main: (303) 504-6510
Fax: (303) 504-6504
Email: HISM@wellpower.org
Hours: Monday to Friday, 8:00 am to 4:30 pm. We are closed on all major holidays. Please see wellpower.org/closures for up-to-date holiday closure information.