Please use the form below to request medical records.


Northeastern Center, Inc abides by all federal and state confidentiality laws including HIPAA (Health Insurance Portability and Accountability Act), and 42 C.F.R. Part 2. By signing this authorization, I acknowledge, accept and agree. This information has been disclosed to you from records in which confidentiality is protected by federal law. Federal Regulations (42 CFE Part 2) prohibit the recipient from making any further disclosure of it without the specific written consent of the person to whom it pertains or except as otherwise permitted by SUD’s regulations. A general authorization for the release of medical or other information is NOT sufficient for this purpose. Information disclosed under 42 C.F.R. Part 2 cannot be used to criminally investigate or prosecute any client with an SUD except as provided for in 42 CFR Section 2.

Northeastern Center, Inc. will respond to all release of information requests within 72 hours. By federal law, all records requests must be completed within 30 calendar days. Per Federal and Indiana State laws, Northeastern Center is required to keep medical records for seven (7) years from the date of service.