How to Obtain Medical Records
Should you require a copy of medical records for yourself or on behalf
of an adult family member, please use the guidelines below. In order to
protect your privacy or the privacy of your loved one, proper identification
will be required to obtain medical records.
If you are requesting medical records on behalf of an adult family member,
the adult family member’s permission (signature) is required.
Requests for copies of medical records for continuing care to be sent directly
to another healthcare provider are free of charge.
For all other requests, there is a reasonable cost based fee for copies
of medical records in accordance with the New Jersey Department of Health
recommendations.
Clara Maass Medical Center
(973) 450-2064
To obtain a copy of a medical record, please print, complete and mail the
medical record release form (available as PDF) to the hospital.
Forms should be sent to:
Attn: Health Information Management
Clara Maass Medical Center
1 Clara Maass Drive
Belleville, New Jersey 07109
Community Medical Center
(732) 557-8136
To receive a copy of your medical records you will need to first complete
our HIPAA compliant authorization forms. Medical Records can only be authorized
to be released by the patient; his/her legally appointed guardian, Medical
Power of Attorney, or another treating healthcare provider. The authorization
form must be completed in its entirety, incomplete forms will be returned
for completion. If you do not know the exact dates of treatment, please
provide as close a date as possible (month and year).
For anyone who needs to request medical records and cannot come down to
the department during our regular business hours; there is a lock box
right outside the Release of Information Office that allows requestors
to fill out a request form and leave it in a drop box for processing by
the Health Information Management Team. If the team has any questions
or concerns; they will contact you on our next business day.
Authority to Disclose Health Information from CMC to Patient/Physician/Facility (available as a PDF)
Request for Release of Health Information to CMC (available as a PDF)
Health Information Management Release of Information Fax number:
732-557-2209.
In the event you are requesting medical records for an
ON STAFF PHYSICIAN,
please note that all physicians have electronic access to our clinical
system for medical records and radiology images, there is no need to request
a copy from CMC Affiliated Physicians. All the patient or a family member has to do is call that physician's
office and let them know of the visit to CMC.
Requests for medical records will not be released to the requestor the
same date the request is received unless it is being faxed to a healthcare
facility or physician’s office for emergency care. Please note,
New Jersey Department of Health standards for release of patient information
allow for a facility to fulfill a request up to 30 days post receipt of request.
Copy Charges for Medical Record Requests
Patient medical record copies will be charged at a rate of .39 cents per
page and will not exceed $200 per admission as per New Jersey State regulations.
Medical Records being requested to be sent directly to other healthcare
providers will be provided free of charge.
Type of Payment Accepted
In advance of your copies being mailed out a fee approval letter will be
provided for your approval of the copying costs associated with the request.
Once the signed approval is returned we will release the medical records.
An invoice will be included with your copies. Payment may be made by check,
money order, and credit/debit card. Checks and money orders can be made
out to Healthport (Healthport provides our Release of Information services.).
If you have any questions or concerns about any part of this process or
would like to follow up on your request for medical records please call
(732) 557-8136 between 8:30 a.m. - 4:30 p.m. Monday, Wednesday, Thursday,
and Friday. Our hours on Tuesdays are: 8:30 a.m. to 5:00 p.m.
When Picking Up Medical Records
Please be sure to bring some type of identification (government issued
preferred with a picture). If someone other than yourself is picking up
the medical records on your behalf; please insure your representative
has a note from you stating it is okay for your representative to pick-up
the records on your behalf. Also the representative must have some type
of identification with them (government issued preferred with a picture).
Forms of acceptable identification: driver's license, passport, etc.).
Jersey City Medical Center
(201) 915-2151
To obtain a copy of a medical record, please print, complete and mail the
medical record release form (available as
fillable PDF) to the hospital.
Attn: Medical Records Department
Jersey City Medical Center
355 Grand Street
Jersey City, New Jersey 07305
Monmouth Medical Center Southern Campus
(732) 886-4451
To obtain a copy of a medical record, please print, complete and mail the
medical record release form (available as PDF) to the hospital.
Attn: Health Information Management
Monmouth Medical Center Southern Campus
600 River Avenue
Lakewood, New Jersey 08701
Monmouth Medical Center/The Unterberg Children's Hospital
(732) 923-7400
To obtain a copy of a medical record, please print, complete and mail the
medical record release form (available as PDF) to the hospital.
Attn: Health Information Management
Monmouth Medical Center
200 Second Ave.
Long Branch, New Jersey 07740
Newark Beth Israel Medical Center/Children's Hospital of New Jersey
(973) 926-7409
To obtain a copy of a medical record, please print, complete and mail the
medical record release form (available as PDF) to the hospital.
Attn: Health Information Management
Newark Beth Israel Medical Center
201 Lyons Avenue at Osborne Terrace,
Newark, New Jersey 07112
Saint Barnabas Medical Center
(973) 322-5835
To obtain a copy of a medical record, please print, complete and mail the
medical record release form (available as PDF) to the hospital.
Attn: Health Information Management
Saint Barnabas Medical Center
94 Old Short Hills Road
Livingston, New Jersey 07039
Barnabas Health Medical Group
Authorization to Obtain Records and Disclose Health Information to Others (available as a PDF)
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