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 a copy of your medical records
- Print and complete the Authorization for Use or Disclosure of Health Information form
- The release form must be completed, dated and signed
- Please be sure to include the date(s) of service requested
- We ask that you specify what components of your medical records you wish to obtain/release.
- 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 your forms 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: