Treatment Record Request

The Alcoholism and Chemical Dependency Programs abide by the federal statutes 42CFR Part 2 and HIPPA (Health Insurance Portability and Accountability Act of 1996) regulations of electronic files in regards to the confidentiality requirements specific to the protection of the material included in the treatment record. Release of program participant information, current or former, to anyone outside of the N.C. Department of Adult Correction without the written authorization of the participant or a properly executed court order is prohibited.

Prison Records
Past program participants who received treatment services within a prison facility may self-request verification of their completed program hours by:

• Completing the Authorization for Release of Information form. Please print legibly when filling in the form.
• Mailing the original form to:

Alcoholism and Chemical Dependency Programs
Quality Assurance Specialist
840 West Morgan Street
MSC 4211
Raleigh, NC 27699-4211
Phone: 919-324-1208

DART (Drug Abuse & Alcoholism Residential Treatment) Center or Black Mountain Substance Abuse Treatment Center for Women Records
Past program participants who received treatment services at either DART Center or Black Mountain may request verification of their completed program hours by:

• Completing the Authorization for Release of Information form. Please print legibly when filling in the form.
• Mailing the original form to the appropriate facility below:

Black Mountain Substance Abuse Treatment Center for Women
Substance Abuse Program Manager
741 Old U.S. Highway 70
Swannanoa, N.C. 28778
Phone: 828-581-4231

DART Center
Substance Abuse Program Manager
1302 W. Ash Street
Goldsboro, N.C. 27530
Phone: 984-960-5425

Other Agencies and Treatment Providers
Past program participants who are involved with official agencies or entities to include: the Division of Social Services (DSS), Vocational Rehabilitation, Administrative Office of the Courts, Federal Probation, a legal attorney, or an authorized substance use disorder treatment provider may have the entity request the verification of the completed program hours. The verification of completed hours will be mailed direct to the requesting entity after submitting their request as follows:

• Complete a properly executed Authorization for Release of Information form in compliance with federal regulations.
• Mail or fax the form to:

Alcoholism and Chemical Dependency Programs
Quality Assurance Standards Specialist
840 West Morgan Street
Raleigh, NC 27699-4211
Fax: 919-204-2836

AA/NA Records
The Alcoholism and Chemical Dependency Programs cannot respond to requests for AA/NA participation at a prison facility. Follow the procedure below to request AA/NA participation information:

• If the requestor is no longer under NCDAC Division of Prisons supervision, requests for AA/NA meeting attendance should be submitted to the prison’s Director of Substance Abuse Programs at 919-838-4000.
• If the requestor is inquiring about an offender who is still under state prison supervision, the requestor should contact the offender's prison case manager where the offender is housed.
• If the requestor is on probation with the Division of Community Supervision, the requestor should contact the offender's probation/parole officer.