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

Youth over 18 years of age, parents/guardians, or health agencies are permitted access to an individual student’s record through an official Records Request or authorization by a parent/guardian and/or the individual. Both FERPA and HIPAA laws allow for the releasing of records without consent by the individual or parent.

Official High School Transcripts must be obtained through the placing Home District.

Green Chimneys is committed to ensuring student privacy in accordance with local, state and federal regulations and district policies. The State Education Department has issued a preliminary Parents’ Bill of Rights for Data Privacy and Security.
View Green Chimneys’ summary of parents’ rights under the new law

Request student 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).


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.


Please note: Green Chimneys records may contain mental health information. This information is obtainable with signed consent.

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 [email protected]  or 845.279.2995 ext. 1211