Click here to view and download a PDF copy of our release of information form

Important: Please use this ROI if you are wanting to find out information about someone over the age of 18’s benefits or service through MINES. If you are a provider or a facility you do not need this form in order to discuss our mutual client with us. This form is only for persons trying to access information about another client (i.e. parent for adult child, spouse for spouse). Please send this completed form back by email ( or fax (303-832-9701). If you have questions, please call us at 800-873-7138.