Requesting Health Records from Eating Recovery Center
We are happy to provide you with copies of your health records. Please complete the authorization form below. After we receive your completed form, we will release your medical records.
Release form checklist
To expedite your request, make sure your form includes the following information:
Full name, including previously used names
Address, including city, state and zip code
Date of birth
Additional necessary information:
The information and date(s) of service you want released
How much information: Pertinent records may include discharge summaries, histories and physicals, or test results
The reason you want the information released
Instructions on whether you want the information faxed or the appropriate mailing information
The date of your request
Your signature, and/or the parent's signature if applicable
Some aspects of your chart require specific authorization. Please review highlighted list and check all the boxes authorized for release. Only authorized records will be sent
If you are unable to sign the request form due to a disability, a guardian or a court-appointed personal representative may sign on your behalf. If there is no guardian or personal representative, the individual with medical power of attorney may sign for the patient. You must provide appropriate legal documentation with the request form if the patient is unable to provide a signature.
Submitting your request form
You can send your record request to us through fax, mail, email, or in person. If you email the form, please attach it as a scanned document.
Address:
Eating Recovery Center
7351 E. Lowry Blvd
Suite 200
Denver, CO 80230
Attention: Medical Records
Fax: 1-720-302-2391 (must dial 1)
Email: MedicalRecordHelp@ERCPathlight.com
Kindly note
It may take up to 15-30 calendar days from the receipt of your request for the medical records request to be fulfilled. However, if we are unable to fulfill the request, we will notify you and share alternative ways to fulfill your request.
Please email us at MedicalRecordHelp@ERCPathlight.com with any questions.