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Human Services

Records Request

Request records from the Human Services department using the form below.

This request for records will be held in our office for 60 days after receipt of this notice. After 60 days, the request will be destroyed. You will need to make a new request in order to retrieve the record.

Douglas County Department of Human Services does not have the authority to release records authored or created by outside agencies or other jurisdictions. You must request those records directly from the person or agency that created the original document.

Your request may result in a fee.  You will be provided an estimated amount before we begin processing your records request.  If you approve the estimate, you will be required to pay the fee prior to the documents being provided.

Department of Human Services Records Request

"*" indicates required fields

Name of Individual Requesting Records*
Address*
Your Relationship to the Case*

Name and Family History

Provide Details on Child(ren) for Records*
Enter each child on the case or for any records being requested. Use the "+" to include additional children (screen size may need to be adjusted to see entire row)
Child's Full Name
Child's DOB
Legal Father
Father DOB
Mother (Legal Name)
Mother DOB
 

Reason for Request

Indicate Reason for Request*
What Documents are you Requesting?
Note, Referral Reports include referrals and investigations. Case Summary includes referral reports, case notes, risk and safety assessments, treatment plan, and court reports.
Please note, the Human Services Department cannot provide documents created by another agency.

Provide Documentation

Drop files here or
Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.

    Confidentiality Statement

    The Department requires an Acknowledgment of Confidentiality (see below) to be signed prior to releasing any record.

    C.R.S. 19-1-307 (4)Any person who improperly releases or who willfully permits or encourages the release of data or information contained in the records and reports of child abuse or neglect to persons not permitted access to such information by this section or by section 19-1-303 commits a class 2 misdemeanor and shall be punished as provided in section 18-1.3-501. Please ensure that should you release records, it is in accordance with legal confidentiality guidelines and privilege requirements.

    Parents/Guardians/Legal Custodians:

    All records obtained through the Douglas County Department of Human Services are strictly confidential. Once you obtain records it is your responsibility to maintain confidentiality and privilege in accordance with legal parameters. Records may be picked up in person at our office or emailed to the requester after the Acknowledgment of Confidentiality and a proper, clear photo ID is received by the record custodian. Please also submit a copy of your driver’s license, legal identification card to provide proof of identity. Requests will not be reviewed or processed until this is received.

    Professionals: Private Attorney’s, CFI/Parental Evaluator’s, etc.

    May not obtain the report from their client(s) and are required to subpoena the department or provide their court order of appointment and release of information signed by both legal parents/guardians. **19-1-103 outlines the need to know this information and our authority to release such records. You may want to ensure that anyone to whom the information is released is informed that they have a legal obligation to maintain the confidentiality of that information. You or your agency could be held responsible for wrongful disclosure. Records will be processed in accordance with subpoena requirements and discovery rules. Otherwise, you will be notified when your records are ready for pick up and or release, we will request an appointment for pick-up be made unless the record is able to be electronically released.

    Law Enforcement/District Attorney/Other DHS Jurisdictions:

    Outside situations where records are needed due to a child protection emergency, the completion of this formal request is required in order to accurately track records requests. A formal request on letterhead may be needed depending on the information requested.

    Acknowledgement of Confidentiality

    I have requested access to information in the Douglas County Department of Human Services files pertaining to an investigation of child abuse or neglect. I acknowledge that the information may not be disseminated or disclosed publicly for any reason as a professional agent.
    By selecting agree below, I acknowledge that I am aware of the confidentiality requirements concerning any information I have obtained from the Department of Human Services.
    AGREEMENT TO CONFIDENTIALITY IS REQUIRED TO SUBMIT THIS FORM.