All medical records are strictly confidential. Information from records will NOT be released to anyone without written authorization of the patient, except as required by law. Medical Records Department can assist you with the following services:
- Requesting medical records for yourself
- Sending medical records from Marin Behavioral Health and Recovery Services to another health facility or provider
Copies of Medical Records
Clients who wish to obtain a copy of their Medical Records may contact the Medical Records Department at 415-473-6779 or email at firstname.lastname@example.org.
Requesting medical records from BHRS is accomplished using the HIPAA compliant forms available in PDF format on this page.
- Release of Information (ROI). The ROI form is used to document the request for release of medical records to the client or authorize the release to a third party (e.g. attorneys or personal representatives).
- Request to Access Health Information. This form is used if a client is requesting access. i.e., to inspect, view or get a copy of their own protected health information.
Forms require an ink signature. Signed completed forms may be returned in person, faxed to 415-473-4113, or mailed to:
Medical Records Department
Behavioral Health and Recovery Services
County of Marin Department of Health and Human Services
250 Bon Air Road, Unit B
Greenbrae, CA 94904
Release of Information Forms
- Release of Information - English.pdf 90.17 KB
- Release of Information - Spanish.pdf 99.64 KB
- Release of Information - Vietnamese.pdf 342.94 KB
- Release of Information - Substance Use Services - ... 250.56 KB
- Release of Information - Substance Use Services - ... 416.78 KB
- Client Request for Health Information.pdf 304.48 KB
- Family Authorization - English.pdf 64.74 KB
- Family Authorization - Spanish.pdf 38.56 KB
- Family Authorization - Vietnamese.pdf 170.99 KB
- Notice of Privacy Practices.pdf 38.46 KB
- Release of Information Revocation Form.pdf 76.22 KB
- Request to Amend Health Record.pdf 177.75 KB