Email a completed and signed release form to MEDICALREQUESTS@GAUDENZIA.ORG, or Fax to (267) 443-5912.
If your release form is not compliant with both HIPAA and 42 CFR Part 2 regulations, we will not be able to fulfill your request. If you are uncertain, please complete and sign the GAUDENZIA RELEASE FORM and email it with your request.
Please allow up to 30 days for requests to be fulfilled.
Gaudenzia’s programs are federally assisted substance use disorder treatment facilities, and are governed by federal regulations – both HIPAA (Health Insurance Portability and Accountability Act) and 42 CFR Part 2 (42 U.S.C. 290dd-2), which regulates the confidentiality of substance use disorder patient records. Standard HIPAA-compliant release forms are not sufficient for the release of substance use disorder-related records. Release forms must also be compliant with 42 CFR Part 2. For further information, click here:
42 CFR Part 2 — Confidentiality of Substance Use Disorder Patient Records
HIPAA – Health Insurance Portability and Accountability Act of 1996