Student Records Policies & Requests

Through its Quality Assurance department, Green Chimneys adheres to New York State guidelines to maintain and monitor proper record-keeping, storage, and destruction of records for all current and former students.

The Family Educational Rights and Privacy Act (FERPA) protects the privacy of student education records. Health Insurance Portability and Accountability Act (HIPAA) mandates industry-wide standards for health care information on electronic billing and other processes, and protects the privacy and security of individually identifiable health information.

Green Chimneys complies with all FERPA and HIPAA requirements in relation to student education and health records, including maintaining a record access log. Green Chimneys maintains the records of students until the age of 27, or 6 years post-discharge. At that time, only demographic data is maintained.

As part of the treatment process, placing district/agency and parent/guardians routinely receive the following documents, including but not limited to:

  • Comprehensive treatment goals
  • Treatment team minutes
  • Report cards
  • IEP progress marks
  • FBA/BIP progress monitoring forms

Parents/guardians, educational institutions and health agencies are permitted access to an individual student’s record through an official Records Request and corresponding authorization by a parent/guardian and/or the individual. Upon request, Green Chimneys will forward educational records to outside schools and to the Home District for the purposes of placement. Official High School Transcripts must be obtained through the placing Home District.

Request Records

To access a student record, complete a Request for Access to Health and Educational Information. This form is for a current parent, parent of an alum, and/or alums themselves (over the age of 18).

Access to Health and Educational Information

To grant permission for release of records, complete an Authorization for the Use and Disclosure of Protected Health Information. This form is used when a parent or youth themselves (over the age of 18) is authorizing Green Chimneys to release records or information directly to another agency. Other agencies requesting records directly may send signed consents to the fax or mailing address below.

Authorization for Protected Health Information 


Forms should be downloaded and completed and signed electronically or by hand.
Please return completed forms to the attention of Records/Quality Assurance via:
Fax  845.279.3077
Mail  Green Chimneys, 400 Doansburg Road, Brewster NY 10509

For questions or information on policies and protocols, please contact Augusta Pereira at apereira@greenchimneys.org  or 845.279.2995 ext. 298