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  • Record Request Form

    Harmony Mental Health Inc. [HMH]

  • RECORD REQUEST DISCLOSURE

    Effective July 1, 2024, Harmony Mental Health, Inc. does require that all Record Request be submitted via this form. This allows for your request to be sent to our database for assignment without any delays in processing.

    Fulfillment Window 

    • Due to staffing shortages and provider schedules we do require a minimum of 30 business days for fulfillment of a record request.
    • When possible we do our best to accommodate preferred delivery dates, there is a field on the request form that allows you to provide us with a preferred delivery date. 
    • Our offices are closed on Fridays and most Federal Holidays. 

    Associated Fees 

    Clients of Harmony may request existing records (intakes, treatment plans, assessments, and progress notes, appt histories) at no additional cost.  

    • Fees may apply for the following: 
      • Processing and Handling Fees 
      • Recommendations for legal proceedings 
      • Completion of external assessments 
      • Standard Documentation Review 
        • Required for all requests made for a provider that is under supervison  
        • Required for all requests made for records produced by a provider no longer employeed at Harmony Mental Health, Inc. 

    If fees apply you will be notified via the contact information provided within 7 business days of your request being received. 

    Harmony will not impose any charge on an indigent person if the medical records are necessary for the purpose of supporting a claim or appeal under any provisions of the Social Security Act, 42 USC §301. 

    Subpoenas: 

    • Must be delivered in-person at our Parkersburg office location at least 7 business days prior to requested testimony or records fulfillment. FEES DO APPLY  
    • Info Needed: Client Full Name, DOB and Provider must be listed. 
    • Deliver To: Our Parkersburg office at 1136 Market St. Parkersburg, WV 26101. 
      • Hours of Operation: T|W|TH 8:00am-6:30pm (Closed for Lunch 12pm-1pm) 
    • Via: Official Carrier or Sheriffs Office
      Attn: Alexandria Williams, Administrative Coordinator or Skylar Davis-Owens, Chief Business Officer

     

  • Record Request Form

    Harmony Mental Health Inc. [HMH]

  • REQUEST DETAILS

    Please be sure to complete all required fields marked (*).
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    • Client Information  
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    • Requester's Information  
    • Request Form  

    • Treatment Dates

      Please list the period we can pull and release records: fill in the "From" and the "To" sections below.
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    • If you opt to complete the authorization form linked below, you will be required to have it signed and submitted within 24 hours of submitting your record request or your request will automatically be moved to "unfulfilled" due to our inability to verify authorization. You will then be required to submit a new request form. 

      Please use the attached link to complete a Harmony Mental Health, Inc. Authorization to Release and Obtain Form. Password to access form: Harmony1! 

      https://pdf.ac/zGuAN

      Please note that to view and submit the authorization form, you must use the same name and email address you provide on this Record Request Form. 

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    • Delivery Preferences

      Delivery Dates and Preferences cannot be guaranteed. However, we will notify you at least 24 hours before your preferred delivery date if we cannot fulfill your request within the preferred timeframe. Please re-review the "HMH Release policies and fees" section above.
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