Client Resources
Resources for Existing Clients
Resources and information to help current clients access services, understand their rights, and get the support they need.
Medical Records Requests
Momentum for Health is not able to release your medical records to you or your designated representative without your written authorization, except as required or permitted by law. At this time, this form does not accept electronic signatures, so it must be printed and completed, including the signature and date.
To request a copy of your Momentum medical record:
- Download the Client Request for Information.
- Sign and date the Client Request.
- Take a photo or scan both sides of the completed Client Request.
- Fax or email along with a photo of your California ID or DL (see fax #/email below).
- Alternatively, send the completed form by mail to the address below.
Requests may take up to 15 calendar days to complete. If there is a delay beyond the 15 days, the Quality Improvement department will contact you.
If you have any questions regarding the release of your medical records from Momentum, you may contact our Quality Improvement Department at 669-213-1206.
Completed forms can be mailed to:
Momentum for Health
Medical Records
1922 The Alameda, Suite 440
San Jose, CA 95126
You can also fax the completed request to 669-213-1419 or email the form to [email protected].
Internal Complaint/Grievance Form
Your feedback is important to us, and we are committed to providing the best possible care and service to all our clients.
If you have experienced dissatisfaction or have concerns regarding the quality of care or services you have received at Momentum for Health, we would like the opportunity to address and resolve them. Your input is invaluable in enhancing our services and ensuring we effectively meet the needs of the community we serve.
You are not required to use this form to file a grievance or complaint.
If you prefer, you may submit your concerns using the following methods:
- In Person: Momentum for Health, 1922 The Alameda, San Jose, CA 95126
(Alternatively, you may deliver it to any Momentum location.) - By Phone: (408) 261-7777
- By Mail: Attention: Quality Improvement Department, 1922 The Alameda, San Jose, CA 95126
- By E-mail: [email protected]
Fill out the Internal Complaint/Grievance Form
Client Information Form
Accessing Services and Support: Frequently Asked Questions (FAQs)
This overview provides a comprehensive guide to accessing services at Momentum for Health. It covers key topics such as:
- How to access care without a referral under the No Wrong Door policy.
- Momentum’s range of services includes outpatient care, residential treatment, crisis intervention, and community support programs.
- Guidance on filing grievances, requesting medical records, and ensuring client confidentiality.
- Frequently asked questions about quality assurance and client rights.
The overview also includes essential crisis hotline numbers, contact details for feedback, and step-by-step instructions for requesting information or medical records.
Consumer Rights and Responsibilities: Informational Document
This document provides an overview of the key rights and responsibilities of individuals receiving services at Momentum for Health. It includes information about:
- The right to humane, non-discriminatory, and confidential care.
- The responsibility to actively participate in treatment and fulfill financial obligations.
- Access to resources for grievances, privacy concerns, and additional assistance.
This document empowers clients to understand their rights while fostering a collaborative approach to care.
