Medical Records

Please see below instructions for requesting records from the following Pathways Entities: Instrucciones y formulario en español.

Pathways Human Services of Florida
Pathways of Massachusetts
Pathways of Oklahoma
Pathways of Texas
Family Preservation Services of West Virginia

Release of Information

A patient, or his/her legal representative, may inspect and/or obtain a copy of their medical records, or have copies of medical records sent to another facility. Pathways requires a completed and signed Authorization for Use or Disclosure of Health Information form along with the additional required documentation before releasing medical records and/or Protected Health Information (PHI) to anyone, including the patient.

How to Request Mental Health Records:

  1. Print and complete the Authorization for Use or Disclosure of Health Information form

  2. The release form must be completed, dated and signed

  3. Please be sure to include the date(s) of service requested

  4. We ask that you specify what components of your medical records you wish to obtain/release.

  5. Forms with any alteration (i.e. Crossed out or white out) will not be honored.

How to Request Substance Use Disorder (SUD) Records:

  1. Follow all instructions under “How to Request Mental Health Records

  2. Print and complete the Consent for Disclosure of SUD Records

  3. The consent form must be completed, dated and signed

  4. Forms with any alteration (i.e. Crossed out or white out) will not be honored.

Additional Required Documentation:

  • A Photocopy of a government issued ID for authorized consenting party

  • Witness Signature on Authorization Form

  • Legal Representatives and/or Guardians must also provide proof of their authority to sign for the patient.

If you have any questions regarding release of information, please email PTW_MedicalRecords@pathways.com or call (844) 200-0334

You may deliver the authorization form along with additional required documentation by mail or fax.

Mail form to:

Pathways by Molina
10304 Spotsylvania Avenue, Suite 300
Fredericksburg, VA 22408
Attention: Medical Records Department

Fax form to:

(540) 710-6447