Release of Information Forms
A signed Release of Information (ROI) Consent Form for all of your providers must be on file with PAS. Completed consent forms may be faxed to (720) 213-1007.
Release of Information – General
Release of Information to Board of Nursing
Release of Information to Colorado Dental Board
Release of Information to Board of Pharmacy
Release of Information to Board of Veterinary Medicine
Release of Information to Board of Addiction Counselor Examiners
Release of Information to Board of Social Work Examiners
Release of Information to Board of Marriage & Family Therapist Examiners
Release of Information to Board of Licensed Professional Counselor Examiners
Release of Information to Board of Registered Psychotherapists
Release of Information to Board of Psychologist Examiners
Authorization for Disclosure of Health Information to Peer Assistance Services, Inc.
Rehabilitation Contract Reports
Rehabilitation Contract reports are due on the 4th of the month.
(Reports for the January reporting period are due February 4th.)
Fax reports to: 720.213.1007 or 720.213.0002
Email reports to: reports@peerassist.org
Notice to clients: Standard email is an unsecured method of correspondence; therefore reports submitted via this method may be at risk for interception. PAS uses ZixCorp encryption for all email communication with clients.
Participants may choose one of the four Self-Status Reports to submit each reporting period, it is not necessary to submit all four versions.
Opiate Replacement Therapy Report
Pain Management Provider Report
PDMP Record Request – Email Receipt
Self Status Education Employment Report