REQUESTING CONFIDENTIAL RECORDS
- To request a copy of a student’s medical, academic, or financial records please complete the form found at the following link: Request for Information
- The link will take you to a DocuSign Release of Confidential Information form.
- Enter your full name and email address and select “Begin Signing”. Do not change the “Operations Manager” information.
- Select “Continue” to open the Release.
- Complete the Release in its entirety. Incomplete Releases will delay processing.
- Select the box to agree to use electronic records and signatures and select “Finish”.
- Once completed, a copy of the Release will be sent to the Operations Manager for processing.
- We will contact you with questions or in the event there is a processing fee.
- The records will be sent to the listed email address.
There is no cost for electronic records if you are a parent or student making a request to be sent to another provider/facility such as a physician’s office or attorney.
Requests from insurance specialists, however, shall be redirected to Lakeside Billing Management and subject to a processing fee. Lakeside Billing Management can be reached at (385) 225-3330 or at firstname.lastname@example.org.
All requests for paper copies shall have the following fees:
The first 5 pages are free
$0.30 per page after the first 5
$6.65 USPS Postage with tracking #
If you are currently enrolled at Gateway, all fees, if any, shall be included in your monthly invoice. All other fees shall be prepaid prior to releasing confidential records.
Please note that Gateway only releases Gateway-generated records. If you are seeking a copy of a record that was not created by Gateway, please contact that provider/facility directly to obtain the record.
Gateway generated records include: treatment and discharge plans, psychiatric assessment at intake, quarterly progress reports, transcripts, admissions forms or some letters of recommendation (confidential letters sent to a school will not be released), teacher notes and report cards.
Gateway non-generated records include: past testing, non-Gateway medical records, IEPs, immunization records, psychological testing, non-Gateway transcripts.
Records shall be released to parents of a minor student. In the event the student is eighteen (18) years of age, the student must sign the Release of Information form.
If you have any questions or issues regarding the confidential records release of information process please contact Millie Butterfield at email@example.com, or at (801) 523-3479.